MEDICARE: DR. MAHMOUD ASSEMI D.C.

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	111N00000X	Chiropractor	DC25643	CA

General Provider Information

NPI Number	:	1477648384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAHMOUD ASSEMI D.C.

Provider Business Mailing Address
First Line	:	PO BOX 27824
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-0824
Country	:	US
Telephone Number	:	323-960-9289
Fax Number	:

Provider Business Practice Location Address
First Line	:	542 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1306
Country	:	US
Telephone Number	:	323-960-9289
Fax Number	:

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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