Healthcare Provider Details

I. General information

NPI: 1790416451
Provider Name (Legal Business Name): MAHDIEH HOSSEINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S CATON AVE
BALTIMORE MD
21229-5201
US

IV. Provider business mailing address

13540 VENTURA BLVD
SHERMAN OAKS CA
91423-3826
US

V. Phone/Fax

Practice location:
  • Phone: 667-234-3120
  • Fax: 667-234-3525
Mailing address:
  • Phone: 667-234-3120
  • Fax: 747-264-0393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number192536
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: