Provider Demographics
NPI:1295734622
Name:MASSOUDIAN, KATRIN ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:KATRIN
Middle Name:ELIZABETH
Last Name:MASSOUDIAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATRIN
Other - Middle Name:ELIZABETH
Other - Last Name:EMLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:18600 S FIGUEROA ST
Mailing Address - Street 2:2ND FLOOR, OB-GYN
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90248-4505
Mailing Address - Country:US
Mailing Address - Phone:310-516-2459
Mailing Address - Fax:
Practice Address - Street 1:18600 S FIGUEROA ST
Practice Address - Street 2:2ND FLOOR, OB-GYN
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90248-4505
Practice Address - Country:US
Practice Address - Phone:310-516-2459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101238474207V00000X
HIMD13496207V00000X
CAA94251207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA170236Medicare UPIN