MEDICARE: DR. ELHAM MAHOOZI

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	171100000X	Acupuncturist	17298	CA

General Provider Information

NPI Number	:	1912403486
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELHAM MAHOOZI

Provider Business Mailing Address
First Line	:	1377 S BEVERLY GLEN BLVD APT 508
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5241
Country	:	US
Telephone Number	:	310-739-0539
Fax Number	:

Provider Business Practice Location Address
First Line	:	1377 S BEVERLY GLEN BLVD APT 508
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-5241
Country	:	US
Telephone Number	:	310-739-0539
Fax Number	:

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

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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