Provider Demographics
NPI:1306943626
Name:MASSEN, ARKADY MICHAILOVICH (MD)
Entity type:Individual
Prefix:
First Name:ARKADY
Middle Name:MICHAILOVICH
Last Name:MASSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:19682 HESPERIAN BLVD STE 101A
Mailing Address - Street 2:1393 SANTA RITA RD. #A
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4752
Mailing Address - Country:US
Mailing Address - Phone:510-783-0536
Mailing Address - Fax:510-315-1103
Practice Address - Street 1:19682 HESPERIAN BLVD STE 101A
Practice Address - Street 2:1393 SANTA RITA RD. #A
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4752
Practice Address - Country:US
Practice Address - Phone:510-783-0536
Practice Address - Fax:510-315-1103
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA527260207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527261Medicare PIN