Provider Demographics
NPI:1992859359
Name:B. DAVID MASSABAND DPM INC
Entity Type:Organization
Organization Name:B. DAVID MASSABAND DPM INC
Other - Org Name:TOWER PODIATRY-THE FOOT AND ANKLE SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MASSABAND
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-657-2828
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 940-E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-657-2828
Mailing Address - Fax:310-657-9733
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 940-E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-657-2828
Practice Address - Fax:310-657-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3989213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39892Medicaid
CA5725880002Medicare NSC
CAU57901Medicare UPIN
CA000E39892Medicaid