# GHIASSI, MD INCORPORATED

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ghiassi MD Incorporated
- **Organization subpart:** No

## Provider details

- **NPI number:** 1235606294
- **Authorized official:** JULEE MEDINA (CLINICAL COORDINATOR)
- **Authorized official phone:** (310) 824-1262

## Contact information

- **Practice address:** 11645 WILSHIRE BLVD STE 702, LOS ANGELES, CA 90025-6807
- **Practice address phone:** (310) 824-1262
- **Practice address fax:** (310) 824-5190
- **Mailing address:** 11645 WILSHIRE BLVD STE 702, LOS ANGELES, CA 90025-6807
- **Mailing address phone:** (310) 824-1262
- **Mailing address fax:** (310) 824-5190

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | NULL | Yes |
| 207XS0106X | Orthopaedic Hand Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/29/2018
- **Last updated:** 10/27/2020