Provider Demographics
NPI:1225287378
Name:AFSHAR, MASOUD (MD)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 N IMPERIAL AVE
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-1265
Mailing Address - Country:US
Mailing Address - Phone:442-283-5049
Mailing Address - Fax:442-283-5089
Practice Address - Street 1:220 N IMPERIAL AVE
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-1265
Practice Address - Country:US
Practice Address - Phone:442-283-5049
Practice Address - Fax:760-283-5089
Is Sole Proprietor?:No
Enumeration Date:2008-09-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA105324207RN0300X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105324OtherCA LICENSE
CABE158YOtherNO CA MEDICARE PTAN
CABE158XOtherSO CA MEDICARE PTAN