Healthcare Provider Details

I. General information

NPI: 1043718992
Provider Name (Legal Business Name): ZANGIABADI MD, A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2018
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 EAST IMPERIAL HWY PATIENT TOWER ROOM #2120
LYNWOOD CA
90262
US

IV. Provider business mailing address

1601 N SEPULVEDA BLVD # 716
MANHATTAN BEACH CA
90266-5111
US

V. Phone/Fax

Practice location:
  • Phone: 310-900-8526
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMIRHOSSEIN ZANGIABADI
Title or Position: OWNER
Credential: MD
Phone: 714-808-9797