Basic Information
| Provider Information | |||||||||
| NPI: | 1164420105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SABBAGH | ||||||||
| FirstName: | MOHAMMED | ||||||||
| MiddleName: | HASSAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1111 W 34TH ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7372795781 | ||||||||
| FaxNumber: | 7372795953 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2005 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD61092467 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0000X | MD61092467 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207RH0003X | TD61092468 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | MD61092467 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0003X | L2619 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 8084N0 | 01 | TX | BCBS | OTHER | 144386302 | 05 | TX | MEDICAID |