MEDICARE: BABAK MOEINOLMOLKI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	D63791	MD
2	208600000X	Surgery Physician	A92803	CA
3	208600000X	Surgery Physician	29841	OK
4	208600000X	Surgery Physician	MD034439	DC
5	208600000X	Surgery Physician	233310	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629003264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BABAK MOEINOLMOLKI M.D.

Provider Business Mailing Address
First Line	:	2080 CENTURY PARK E
Second Line	:	SUITE 1508
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2001
Country	:	US
Telephone Number	:	310-694-4486
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 BROCKTON AVE
Second Line	:	STE 205
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1372
Country	:	US
Telephone Number	:	310-694-4486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/25/2015

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