Provider Demographics
NPI:1952367070
Name:AGAHI, MASSOUD H (MD)
Entity Type:Individual
Prefix:DR
First Name:MASSOUD
Middle Name:H
Last Name:AGAHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MASSOUD
Other - Middle Name:
Other - Last Name:HAJI-AGHAII
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 573099
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3099
Mailing Address - Country:US
Mailing Address - Phone:310-657-8237
Mailing Address - Fax:844-769-8008
Practice Address - Street 1:8750 WILSHIRE BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2703
Practice Address - Country:US
Practice Address - Phone:310-657-8237
Practice Address - Fax:844-769-8008
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG758322086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G758320Medicaid
CAF47143Medicare UPIN
CAG75832Medicare ID - Type UnspecifiedMEDICARE PROVIDER #