Basic Information
| Provider Information | |||||||||
| NPI: | 1154736007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAQOOB | ||||||||
| FirstName: | MAIDAH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4140 W 190TH ST | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905045513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109671780 | ||||||||
| FaxNumber: | 8669914287 | ||||||||
| Practice Location | |||||||||
| Address1: | 8723 ALDEN DR | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104238784 | ||||||||
| FaxNumber: | 3104232665 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2014 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/23/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 260343 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 036146740 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | A172055 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.