Provider Demographics
NPI:1154413516
Name:HOSEIN MOHAMMADI, M.D., INC.
Entity type:Organization
Organization Name:HOSEIN MOHAMMADI, M.D., INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHAMMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-846-4985
Mailing Address - Street 1:10120 DUTCH IRIS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3770
Mailing Address - Country:US
Mailing Address - Phone:661-664-3670
Mailing Address - Fax:661-664-7929
Practice Address - Street 1:5000 PHYSICIANS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-5835
Practice Address - Country:US
Practice Address - Phone:661-846-4985
Practice Address - Fax:661-846-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A338200174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22470ZMedicare ID - Type UnspecifiedMEDICARE ID FOR GROUP