Provider Demographics
NPI:1578633913
Name:MASOUD, ABDUL SAMAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDUL
Middle Name:SAMAD
Last Name:MASOUD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W COMPTON BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90220-3099
Mailing Address - Country:US
Mailing Address - Phone:310-639-7200
Mailing Address - Fax:310-639-0200
Practice Address - Street 1:555 W COMPTON BLVD STE 104
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90220-3099
Practice Address - Country:US
Practice Address - Phone:310-639-7200
Practice Address - Fax:310-639-0200
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ03316ZOtherBLUE SHEILD #
CA00A484040Medicaid
CAA48404OtherMEDICAL LICENSE #
CAP00121487OtherCHAMPUS #
CAD28439Medicare UPIN
CAA48404OtherMEDICAL LICENSE #