# EHSAN MOSHFEGH MD INC

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

## Provider details

- **NPI number:** 1063726164
- **Authorized official:** EHSAN MOSHFEGH M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 246-4172

## Contact information

- **Practice address:** 1115 S ROBERTSON BLVD, LOS ANGELES, CA 90035-1403
- **Practice address phone:** (310) 246-4171
- **Mailing address:** 10701 WILSHIRE BLVD, SUITE \# 1103, LOS ANGELES, CA 90024-4401
- **Mailing address phone:** (310) 246-4172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A42194 | CA | Yes |

## Other

- **Enumeration date:** 07/30/2010
- **Last updated:** 08/06/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A421940 | — | CA |