Provider Demographics
NPI:1679293724
Name:WOUND DOCTORS
Entity Type:Organization
Organization Name:WOUND DOCTORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUREHNISSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-889-5447
Mailing Address - Street 1:575 E HARDY ST STE 312
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4050
Mailing Address - Country:US
Mailing Address - Phone:661-630-4343
Mailing Address - Fax:661-630-4344
Practice Address - Street 1:575 E HARDY ST STE 312
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4050
Practice Address - Country:US
Practice Address - Phone:661-630-4343
Practice Address - Fax:661-630-4344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-30
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty