Healthcare Provider Details

I. General information

NPI: 1801078050
Provider Name (Legal Business Name): KIYA MOVASSAGHI MD. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 S. GARDEN WAY SUITE 100
EUGENE OR
97401
US

IV. Provider business mailing address

330 S. GARDEN WAY, SUITE 100
EUGENE OR
97401
US

V. Phone/Fax

Practice location:
  • Phone: 541-686-8700
  • Fax: 541-686-9004
Mailing address:
  • Phone: 541-686-8700
  • Fax: 541-686-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD23767
License Number StateOR

VIII. Authorized Official

Name: DR. KIYA MOVASSAGHI
Title or Position: PATIENT ACCTS
Credential: M.D. P.C.
Phone: 541-686-8700