Provider Demographics
NPI:1801078050
Name:KIYA MOVASSAGHI MD. P.C.
Entity type:Organization
Organization Name:KIYA MOVASSAGHI MD. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCTS
Authorized Official - Prefix:DR
Authorized Official - First Name:KIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOVASSAGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:541-686-8700
Mailing Address - Street 1:330 S. GARDEN WAY,
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401
Mailing Address - Country:US
Mailing Address - Phone:541-686-8700
Mailing Address - Fax:541-686-9004
Practice Address - Street 1:330 S. GARDEN WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401
Practice Address - Country:US
Practice Address - Phone:541-686-8700
Practice Address - Fax:541-686-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23767174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR286507Medicaid
ORH60850Medicare UPIN
ORR113107Medicare PIN