Provider Demographics
NPI:1417056151
Name:KAZEMI, MASSUMA (MD)
Entity Type:Individual
Prefix:
First Name:MASSUMA
Middle Name:
Last Name:KAZEMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 LAREN LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-6710
Mailing Address - Country:US
Mailing Address - Phone:972-566-7677
Mailing Address - Fax:972-566-6141
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:BLDG C #208
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2505
Practice Address - Country:US
Practice Address - Phone:972-566-7677
Practice Address - Fax:972-566-6141
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG65402080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE77192Medicare UPIN