Provider Demographics
NPI:1275129603
Name:HOSSEIN MASOOMI, MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HOSSEIN MASOOMI, MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASOOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-257-3143
Mailing Address - Street 1:4150 REGENTS PARK ROW STE 300
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1417
Mailing Address - Country:US
Mailing Address - Phone:858-909-9000
Mailing Address - Fax:858-909-9009
Practice Address - Street 1:4150 REGENTS PARK ROW STE 300
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1417
Practice Address - Country:US
Practice Address - Phone:858-909-9000
Practice Address - Fax:858-909-9009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty