Provider Demographics
NPI:1619506185
Name:DAHAB, TALAL MOHAMMED SAYED
Entity type:Individual
Prefix:
First Name:TALAL
Middle Name:MOHAMMED SAYED
Last Name:DAHAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST # 461
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502-2059
Mailing Address - Country:US
Mailing Address - Phone:424-306-8070
Mailing Address - Fax:310-533-1841
Practice Address - Street 1:1000 W CARSON ST # 461
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2059
Practice Address - Country:US
Practice Address - Phone:424-306-8070
Practice Address - Fax:310-533-1841
Is Sole Proprietor?:No
Enumeration Date:2020-04-06
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN30769208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery