Healthcare Provider Details

I. General information

NPI: 1114347804
Provider Name (Legal Business Name): HOSSEIN MAHBOUBI M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2014
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 480
LOS ANGELES CA
90017-5809
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 480
LOS ANGELES CA
90017-5809
US

V. Phone/Fax

Practice location:
  • Phone: 213-483-9930
  • Fax: 562-967-2363
Mailing address:
  • Phone: 213-483-9930
  • Fax: 562-967-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberA145231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: