Basic Information
| Provider Information | |||||||||
| NPI: | 1356467112 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSHAN | ||||||||
| FirstName: | WESAM | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3401 W SUNFLOWER AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927046948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149921182 | ||||||||
| FaxNumber: | 5628034500 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 W SUNFLOWER AVE STE 250 | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149921182 | ||||||||
| FaxNumber: | 5628034500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 13160 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | ASO2532199253 | 01 | NV | DEA CERTIFICATE | OTHER | LL1702 | 01 | NV | MEDICAL LICENSE | OTHER |