Organization
EHSAN MOSHFEGH MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EHSAN MOSHFEGH M.D. (MEDICAL DIRECTOR)
(310) 246-4172
Entity
Organization
Contact information
Practice address
1115 S ROBERTSON BLVD, LOS ANGELES, CA 90035-1403
(310) 246-4171
Mailing address
10701 WILSHIRE BLVD, SUITE # 1103, LOS ANGELES, CA 90024-4401
(310) 246-4172
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A42194
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A421940
—
CA
Enumeration date
07/30/2010
Last updated
08/06/2010
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