Provider Demographics
NPI:1629953021
Name:KERSHAH, MOHAMED AMR MOHAMED SAAD
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:AMR MOHAMED SAAD
Last Name:KERSHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 W POMONA AVE UNIT 309
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4840
Mailing Address - Country:US
Mailing Address - Phone:909-561-0421
Mailing Address - Fax:
Practice Address - Street 1:228 W POMONA AVE UNIT 309
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-4840
Practice Address - Country:US
Practice Address - Phone:909-561-0421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-06
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator