Provider Demographics
NPI:1457476426
Name:MUNASSI, DOMINIC TASHI (MD)
Entity Type:Individual
Prefix:
First Name:DOMINIC
Middle Name:TASHI
Last Name:MUNASSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DOMINICK
Other - Middle Name:TASHI
Other - Last Name:MUNASSI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9333 EAST IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242
Mailing Address - Country:US
Mailing Address - Phone:562-657-7000
Mailing Address - Fax:
Practice Address - Street 1:9333 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2812
Practice Address - Country:US
Practice Address - Phone:562-657-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLL1694390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVLL1694OtherMEDICAL LICENSE
NVLL1694OtherMEDICAL LICENSE
NVASO2532199211OtherDEA CERTIFICATE
CABX558YMedicare PIN