Provider Demographics
NPI:1306161963
Name:MAASUMI, KASRA (MD)
Entity type:Individual
Prefix:DR
First Name:KASRA
Middle Name:
Last Name:MAASUMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23052 ALICIA PKWY STE H314
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-1643
Mailing Address - Country:US
Mailing Address - Phone:949-290-2372
Mailing Address - Fax:
Practice Address - Street 1:30212 TOMAS STE 180
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-2174
Practice Address - Country:US
Practice Address - Phone:949-599-7400
Practice Address - Fax:949-599-1430
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA1185122084N0400X, 2084P2900X
CAA118512208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine