Provider Demographics
NPI:1669570495
Name:BADRI, MOHSEN (MD, DO, MPH)
Entity type:Individual
Prefix:DR
First Name:MOHSEN
Middle Name:
Last Name:BADRI
Suffix:
Gender:M
Credentials:MD, DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11819 WILSHIRE BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6631
Mailing Address - Country:US
Mailing Address - Phone:310-914-9246
Mailing Address - Fax:310-478-5850
Practice Address - Street 1:11819 WILSHIRE BLVD
Practice Address - Street 2:SUITE #208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-914-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2018-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine