Provider Demographics
NPI:1417056391
Name:MOE AMADPOUR MD INC
Entity Type:Organization
Organization Name:MOE AMADPOUR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOE
Authorized Official - Middle Name:
Authorized Official - Last Name:AMADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-583-2643
Mailing Address - Street 1:PO BOX 800817
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-0817
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:1159 ROADRUNNER WAY
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-3159
Practice Address - Country:US
Practice Address - Phone:805-583-2643
Practice Address - Fax:805-583-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81182207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG81182OtherPRESIDENT'S MCARE ID#
CAG81182OtherPRESIDENT'S MCARE ID#