Provider Demographics
NPI:1578585550
Name:ALLEN MASSIHI, PODIATRIC INC.
Entity Type:Organization
Organization Name:ALLEN MASSIHI, PODIATRIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR PODIATRIC MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSIHI
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-748-7319
Mailing Address - Street 1:4058 WOODCLIFF RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4334
Mailing Address - Country:US
Mailing Address - Phone:818-748-7319
Mailing Address - Fax:
Practice Address - Street 1:311 N VERDUGO RD
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-3944
Practice Address - Country:US
Practice Address - Phone:818-409-9912
Practice Address - Fax:818-553-1720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4353213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E43531Medicaid
CAW16777Medicare PIN
CAU85985Medicare UPIN