Provider Demographics
NPI:1710585328
Name:EMPIRE MEDICAL SPECIALIST
Entity Type:Organization
Organization Name:EMPIRE MEDICAL SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHOUBIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-909-9151
Mailing Address - Street 1:28625 QUAINT ST
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1735
Mailing Address - Country:US
Mailing Address - Phone:917-909-9151
Mailing Address - Fax:
Practice Address - Street 1:28625 QUAINT ST
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1735
Practice Address - Country:US
Practice Address - Phone:917-909-9151
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty