Healthcare Provider Details

I. General information

NPI: 1417695230
Provider Name (Legal Business Name): MEHDI A. MOGHADAM, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7232 VANNUYS BLD SUIT 201
VANNUYS CA
91405
US

IV. Provider business mailing address

PO BOX 420
VANNUYS CA
91408
US

V. Phone/Fax

Practice location:
  • Phone: 818-373-4999
  • Fax: 818-373-4998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: MEHDI AMINI MOGHADAM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-415-2293