Provider Demographics
NPI:1861692667
Name:ASHRAF ELSAYEGH MD A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:ASHRAF ELSAYEGH MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:ELSAYEGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-556-0335
Mailing Address - Street 1:2080 CENTURY PARK E STE 507
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2008
Mailing Address - Country:US
Mailing Address - Phone:310-556-0335
Mailing Address - Fax:310-556-0330
Practice Address - Street 1:2080 CENTURY PARK E STE 507
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2008
Practice Address - Country:US
Practice Address - Phone:310-556-0335
Practice Address - Fax:310-556-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77236207KA0200X, 207RC0200X, 207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Single Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI32187Medicare UPIN