Provider Demographics
NPI:1154518629
Name:MOVASSAGHI, MEHRAN (MD)
Entity type:Individual
Prefix:
First Name:MEHRAN
Middle Name:
Last Name:MOVASSAGHI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1407
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-277-2929
Mailing Address - Fax:
Practice Address - Street 1:2001 SANTA MONICA BLVD STE 460W
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2178
Practice Address - Country:US
Practice Address - Phone:310-582-7333
Practice Address - Fax:310-315-6157
Is Sole Proprietor?:No
Enumeration Date:2007-09-28
Last Update Date:2022-11-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA101122208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology