Provider Demographics
NPI:1275228421
Name:NIMA MASSOOMI DME MED MD INC.
Entity Type:Organization
Organization Name:NIMA MASSOOMI DME MED MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSOOMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DMD, MED
Authorized Official - Phone:408-358-5000
Mailing Address - Street 1:15780 LOS GATOS BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2508
Mailing Address - Country:US
Mailing Address - Phone:408-358-5000
Mailing Address - Fax:408-358-7936
Practice Address - Street 1:15780 LOS GATOS BLVD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2508
Practice Address - Country:US
Practice Address - Phone:408-358-5000
Practice Address - Fax:408-358-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-05
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery