MEDICARE: MAJID MOLAIE M.D.

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	174400000X	Specialist	A37634	CA

General Provider Information

NPI Number	:	1356411904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAJID MOLAIE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6189
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90734-6189
Country	:	US
Telephone Number	:	310-514-8034
Fax Number	:	310-833-3508

Provider Business Practice Location Address
First Line	:	28924 S. WESTERN AVE.
Second Line	:	#201
City	:	RANCHO PALOS VERDES
State	:	CA
Zip	:	90275-0885
Country	:	US
Telephone Number	:	310-514-8034
Fax Number	:	310-833-3508

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	01/14/2010

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