Healthcare Provider Details

I. General information

NPI: 1174432157
Provider Name (Legal Business Name): ROBERT B. MOGHIMI MD INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 SWALLOW LN
SIMI VALLEY CA
93065-3154
US

IV. Provider business mailing address

4228 AGNES AVE
STUDIO CITY CA
91604-2019
US

V. Phone/Fax

Practice location:
  • Phone: 805-526-6016
  • Fax: 805-791-3992
Mailing address:
  • Phone: 805-526-6016
  • Fax: 805-791-3992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT B MOGHIMI
Title or Position: PROVIDER
Credential: MD
Phone: 818-517-8279