Provider Demographics
NPI:1629022736
Name:MODY, CYRUS K (MD)
Entity type:Individual
Prefix:
First Name:CYRUS
Middle Name:K
Last Name:MODY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8733 BEVERLY BLVD
Mailing Address - Street 2:#404
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1827
Mailing Address - Country:US
Mailing Address - Phone:310-659-8451
Mailing Address - Fax:310-659-6620
Practice Address - Street 1:8733 BEVERLY BLVD
Practice Address - Street 2:#404
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1827
Practice Address - Country:US
Practice Address - Phone:310-659-8451
Practice Address - Fax:310-659-6620
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2024-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA411062084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A411060Medicaid
CA00A411060Medicaid
CAA41106Medicare ID - Type Unspecified