Basic Information
| Provider Information | |||||||||
| NPI: | 1225200637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YOUSSEF | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | MAGDY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7001 | ||||||||
| Address2: | |||||||||
| City: | TARZANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913577001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188887815 | ||||||||
| FaxNumber: | 8187151722 | ||||||||
| Practice Location | |||||||||
| Address1: | 1551 OCEAN AVE | ||||||||
| Address2: | STE.#200 | ||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904012108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104340044 | ||||||||
| FaxNumber: | 3104340099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2008 | ||||||||
| LastUpdateDate: | 11/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A77473 | CA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208200000X | A77473 | CA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 208600000X | A77473 | CA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.