Basic Information
| Provider Information | |||||||||
| NPI: | 1982751814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOUGH | ||||||||
| FirstName: | GALAL | ||||||||
| MiddleName: | SAMUEL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8655 FRESNO CIR UNIT 502C | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926465731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103875585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13132 STUDEBAKER RD STE 9 | ||||||||
| Address2: | |||||||||
| City: | NORWALK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906502575 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628683751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A21076 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | A21076 | 01 | CA | MEDICAL LICENSE | OTHER |