Provider Demographics
NPI:1437689460
Name:MOGHADAM, CHRISTINA ASAL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:ASAL
Last Name:MOGHADAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1923 SELBY AVE # 301
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5866
Mailing Address - Country:US
Mailing Address - Phone:702-480-8411
Mailing Address - Fax:
Practice Address - Street 1:416 N BEDFORD DR STE 300
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4309
Practice Address - Country:US
Practice Address - Phone:310-273-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008578152W00000X
CA34559152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist