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General NPI Number Information
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NPI Number | 1114088630
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Entity Type | Organization
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Legal Business Name | MOSHE FAYNSOD, M.D. INC
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1360 W 6TH ST SUITE 315
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-514-1150
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 W 6TH ST SUITE 315
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City | SAN PEDRO
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State | CA
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Zip | 90732-3514
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Country | US
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Telephone | 310-514-1150
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOSHE FAYNSOD
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Credential | M.D.
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Telephone | 310-514-1150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | AO65167
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License Number State | CA
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