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General NPI Number Information
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NPI Number | 1063726164
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Entity Type | Organization
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Legal Business Name | EHSAN MOSHFEGH MD INC
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Dates
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Enumeration Date | 07/30/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 1115 S ROBERTSON BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90035-1403
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Country | US
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Telephone | 310-246-4171
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Fax |
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Provider Business Mailing Address
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Address Line | 10701 WILSHIRE BLVD SUITE # 1103
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City | LOS ANGELES
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State | CA
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Zip | 90024-4401
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Country | US
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Telephone | 310-246-4172
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | EHSAN MOSHFEGH
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Credential | M.D.
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Telephone | 310-246-4172
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A42194
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License Number State | CA
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