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General NPI Number Information
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NPI Number | 1821215302
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Entity Type | Individual
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Provider Name | SASSAN DAVOUDI MD
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Gender | Male
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 1300 N VERMONT AVE
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City | LOS ANGELES
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State | CA
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Zip | 90027-6005
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Country | US
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Telephone | 323-913-4592
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Fax |
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Provider Business Mailing Address
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Address Line | 5071 GARDEN GROVE AVE
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City | TARZANA
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State | CA
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Zip | 91356-4317
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Country | US
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Telephone | 818-345-6655
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A90942
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License Number State | CA
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