Provider Demographics
NPI:1881868065
Name:YOUSEFPOUR, MAHKAMEH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MAHKAMEH
Middle Name:
Last Name:YOUSEFPOUR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 E FLORENCE AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4708
Mailing Address - Country:US
Mailing Address - Phone:323-588-5343
Mailing Address - Fax:323-588-1780
Practice Address - Street 1:2660 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4708
Practice Address - Country:US
Practice Address - Phone:323-588-5343
Practice Address - Fax:323-588-1780
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4751213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4751OtherSTATE LICENSE
CAE4751OtherSTATE LICENSE