# CASPIAN MEDICAL CLINIC, CORP

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

## Provider details

- **NPI number:** 1275765612
- **Authorized official:** DR. MAX MAHMOUD GHANNADI M.D., (OWNER)
- **Authorized official phone:** (818) 994-0000

## Contact information

- **Practice address:** 14103 VICTORY BLVD, SUITE 7, VAN NUYS, CA 91401-1998
- **Practice address phone:** (818) 994-0000
- **Practice address fax:** (818) 988-2949
- **Mailing address:** 14103 VICTORY BLVD, SUITE 7, VAN NUYS, CA 91401-1998
- **Mailing address phone:** (818) 994-0000
- **Mailing address fax:** (818) 988-2949

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A102618 | CA | Yes |

## Other

- **Enumeration date:** 08/19/2009
- **Last updated:** 09/23/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | A102618 | LICENSE | CA |