Provider Demographics
NPI:1265468714
Name:SAFAEIAN, MASOUD (DC)
Entity Type:Individual
Prefix:
First Name:MASOUD
Middle Name:
Last Name:SAFAEIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 E ARBOR VITAE ST
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-3450
Mailing Address - Country:US
Mailing Address - Phone:310-672-4110
Mailing Address - Fax:310-672-0181
Practice Address - Street 1:426 E ARBOR VITAE ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-3450
Practice Address - Country:US
Practice Address - Phone:310-672-4110
Practice Address - Fax:310-672-0181
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27287111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC27287AMedicare ID - Type Unspecified