MEDICARE: MEHRAN MOVASSAGHI MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	A101122	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A101122	OTHER	CA	MEDICAL STATE LICENSE

General Provider Information

NPI Number	:	1194102947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEHRAN MOVASSAGHI MD INC

Provider Business Mailing Address
First Line	:	2080 CENTURY PARK EAST
Second Line	:	SUITE 1407
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2017
Country	:	US
Telephone Number	:	310-277-2929
Fax Number	:	310-709-8094

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK EAST
Second Line	:	SUITE 1407
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2017
Country	:	US
Telephone Number	:	310-277-2929
Fax Number	:	310-709-8094

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEHRAN MOVASSAGHI
Credential	:	MD
Telephone Number	:	310-277-2929

Provider Enumeration Date	:	04/30/2015
Last Update Date	:	04/30/2015

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Directions to “MEHRAN MOVASSAGHI MD INC ” Practice Location

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