Provider Demographics
NPI:1063450351
Name:MASSOUDI, NAVID H (MD)
Entity Type:Individual
Prefix:
First Name:NAVID
Middle Name:H
Last Name:MASSOUDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NAVID
Other - Middle Name:MASOUD
Other - Last Name:HAMEDANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:17909 SOLEDAD CANYON RD
Practice Address - Street 2:
Practice Address - City:CANYON COUNTRY
Practice Address - State:CA
Practice Address - Zip Code:91387-3210
Practice Address - Country:US
Practice Address - Phone:661-250-5230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237788207R00000X
CAA84167207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A841670Medicaid
CA00A841670Medicaid
WA84167BMedicare PIN
CABD021YMedicare PIN