Healthcare Provider Details

I. General information

NPI: 1477894640
Provider Name (Legal Business Name): NASKON MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3769 BEVERLY RIDGE DR
SHERMAN OAKS CA
91423-4508
US

IV. Provider business mailing address

3769 BEVERLY RIDGE DR
SHERMAN OAKS CA
91423-4508
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9573
  • Fax: 951-304-3653
Mailing address:
  • Phone: 951-461-9573
  • Fax: 951-304-3653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A 11370
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HAMID NASSERI
Title or Position: D.O.
Credential: D.O.
Phone: 951-461-9573