Provider Demographics
NPI:1548322381
Name:HUMAYUN, MARK S (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:HUMAYUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-7152
Mailing Address - Fax:323-442-7166
Practice Address - Street 1:1450 SAN PABLO ST
Practice Address - Street 2:SUITE 4000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-4668
Practice Address - Country:US
Practice Address - Phone:323-442-6311
Practice Address - Fax:323-442-7166
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA52637207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A526370OtherBLUE SHIELD
CA00A526370OtherBLUE SHIELD
CA930111427OtherMEDICARE RAILROAD
CAF64003Medicare UPIN
CA00A526370Medicaid
CA00A526370OtherBLUE SHIELD