Provider Demographics
NPI:1386839249
Name:TAVOUSSI, MOHSEN (DO)
Entity Type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:TAVOUSSI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9209 COLIMA RD STE 2300
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-1817
Mailing Address - Country:US
Mailing Address - Phone:866-503-3223
Mailing Address - Fax:714-375-0599
Practice Address - Street 1:9209 COLIMA RD STE 2300
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-1817
Practice Address - Country:US
Practice Address - Phone:866-503-3223
Practice Address - Fax:714-375-0599
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6170207YX0905X, 207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE88349Medicare UPIN