Healthcare Provider Details

I. General information

NPI: 1548953680
Provider Name (Legal Business Name): MOHSEN BASIRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SKYPARK DR STE 310
TORRANCE CA
90505-5399
US

IV. Provider business mailing address

244 MADISON AVE STE 141
NEW YORK NY
10016-2817
US

V. Phone/Fax

Practice location:
  • Phone: 858-295-0501
  • Fax: 308-646-6140
Mailing address:
  • Phone: 669-201-0667
  • Fax: 818-616-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number210286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: