Provider Demographics
NPI:1477648384
Name:ASSEMI, MAHMOUD (DC)
Entity type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:ASSEMI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27824
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0824
Mailing Address - Country:US
Mailing Address - Phone:323-960-9289
Mailing Address - Fax:
Practice Address - Street 1:542 N LARCHMONT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1306
Practice Address - Country:US
Practice Address - Phone:323-960-9289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25643111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU89548Medicare ID - Type Unspecified