# HUSAM ELIAS MD DMD INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104299833
- **Authorized official:** HUSAM ELIAS MD DMD FACS (PRESIDENT)
- **Authorized official phone:** (818) 789-6622

## Contact information

- **Practice address:** 4910 VAN NUYS BLVD, SUITE 102, SHERMAN OAKS, CA 91403-1715
- **Practice address phone:** (818) 789-6622
- **Mailing address:** 4910 VAN NUYS BLVD, SUITE 102, SHERMAN OAKS, CA 91403-1715
- **Mailing address phone:** (818) 789-6622

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | A113977 | CA | Yes |

## Other

- **Enumeration date:** 11/03/2015
- **Last updated:** 11/03/2015