Healthcare Provider Details

I. General information

NPI: 1821157298
Provider Name (Legal Business Name): MOINUDDIN HABIB MOKHASHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 08/01/2023
Certification Date: 08/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25078 PEACHLAND AVE STE A
NEWHALL CA
91321-2558
US

IV. Provider business mailing address

PO BOX 20878
BAKERSFIELD CA
93390-0878
US

V. Phone/Fax

Practice location:
  • Phone: 661-253-4420
  • Fax:
Mailing address:
  • Phone: 504-343-6823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA155607
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberA155607
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: