Provider Demographics
NPI:1639343460
Name:MASOUD SADIGHPOUR, MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MASOUD SADIGHPOUR, MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MASOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SADIGHPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-461-9070
Mailing Address - Street 1:16542 VENTURA BLVD
Mailing Address - Street 2:302
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2005
Mailing Address - Country:US
Mailing Address - Phone:818-461-9070
Mailing Address - Fax:888-754-1253
Practice Address - Street 1:16542 VENTURA BLVD
Practice Address - Street 2:302
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2005
Practice Address - Country:US
Practice Address - Phone:818-461-9070
Practice Address - Fax:888-754-1253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2015-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88186261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA149955Medicare UPIN