Provider Demographics
NPI:1467499350
Name:VOSOGHI, MEHRDAD (MD)
Entity Type:Individual
Prefix:DR
First Name:MEHRDAD
Middle Name:
Last Name:VOSOGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:612 S BARRINGTON AVE
Mailing Address - Street 2:#414
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4430
Mailing Address - Country:US
Mailing Address - Phone:310-924-5494
Mailing Address - Fax:562-464-9134
Practice Address - Street 1:5901 W OLYMPIC BLVD
Practice Address - Street 2:#300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-4667
Practice Address - Country:US
Practice Address - Phone:310-556-7747
Practice Address - Fax:310-556-7757
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73291207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73291Medicare PIN