MEDICARE: DR. MASSOUD H. AGAHI 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	2086S0129X	Vascular Surgery Physician	G75832	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952367070
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MASSOUD H. AGAHI M.D.

Provider Business Mailing Address
First Line	:	PO BOX 573099
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91357-3099
Country	:	US
Telephone Number	:	310-657-8237
Fax Number	:	844-769-8008

Provider Business Practice Location Address
First Line	:	8750 WILSHIRE BLVD
Second Line	:	SUITE 150
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2703
Country	:	US
Telephone Number	:	310-657-8237
Fax Number	:	844-769-8008

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

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	05/05/2016

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