Provider Demographics
NPI:1841354073
Name:MOJGAN MAKHSOOSI, M.D. INC.
Entity type:Organization
Organization Name:MOJGAN MAKHSOOSI, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MOJGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKHSOOSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-915-0315
Mailing Address - Street 1:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91359-6604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2750 SYCAMORE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1502
Practice Address - Country:US
Practice Address - Phone:805-915-0315
Practice Address - Fax:805-915-0317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70736207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG94619Medicare UPIN