Provider Demographics
NPI:1073549283
Name:MASSEN MEDICAL OFFICE
Entity Type:Organization
Organization Name:MASSEN MEDICAL OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ARKADY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-783-0536
Mailing Address - Street 1:19682 HESPERIAN BLVD
Mailing Address - Street 2:1393 SANTA RITA RD., #A
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4752
Mailing Address - Country:US
Mailing Address - Phone:510-783-0536
Mailing Address - Fax:510-315-1103
Practice Address - Street 1:19682 HESPERIAN BLVD
Practice Address - Street 2:1393 SANTA RITA RD., #A
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:510-783-0536
Practice Address - Fax:510-315-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA527260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty