Provider Demographics
NPI:1568765915
Name:FOOT & ANKLE PHYSICIANS & SURGEONS, PC
Entity Type:Organization
Organization Name:FOOT & ANKLE PHYSICIANS & SURGEONS, PC
Other - Org Name:HOLLYWOOD FOOT & ANKLE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAJID
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-912-9220
Mailing Address - Street 1:710 S MYRTLE AVE
Mailing Address - Street 2:105
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3423
Mailing Address - Country:US
Mailing Address - Phone:248-835-0121
Mailing Address - Fax:323-206-5251
Practice Address - Street 1:17777 VENTURA BLVD
Practice Address - Street 2:252
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3736
Practice Address - Country:US
Practice Address - Phone:323-912-9220
Practice Address - Fax:323-206-5251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4877213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1194040071OtherINDIVIDUAL NPI NUMBER