Healthcare Provider Details

I. General information

NPI: 1437187028
Provider Name (Legal Business Name): MOHAMMAD A POURSHAHMIR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5353 BALBOA BLVD STE 201
ENCINO CA
91316-2865
US

IV. Provider business mailing address

4400 W RIVERSIDE DR # 110-2780
BURBANK CA
91505-4046
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-7277
  • Fax: 818-783-9607
Mailing address:
  • Phone: 818-783-7277
  • Fax: 818-783-9607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA78449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: