Healthcare Provider Details

I. General information

NPI: 1609930858
Provider Name (Legal Business Name): MASSOUD AMINI M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 03/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7143 SEVILLE AVE
HUNTINGTON PARK CA
90255-4905
US

IV. Provider business mailing address

PO BOX 126
HUNTINGTON PARK CA
90255-0126
US

V. Phone/Fax

Practice location:
  • Phone: 323-587-0145
  • Fax: 323-587-6591
Mailing address:
  • Phone: 323-587-0145
  • Fax: 323-587-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MASSOUD AMINI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 323-587-0145