Provider Demographics
NPI:1821292368
Name:MASSOUD H. AGAHI, M.D. INC.
Entity Type:Organization
Organization Name:MASSOUD H. AGAHI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:H
Authorized Official - Last Name:AGAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-657-8237
Mailing Address - Street 1:8635 W 3RD ST
Mailing Address - Street 2:SUITE 865-W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-657-8237
Mailing Address - Fax:310-659-2937
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 865-W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-657-8237
Practice Address - Fax:310-659-2937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG758322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G758320Medicaid
W20843Medicare PIN
CAF47143Medicare UPIN