Provider Demographics
NPI:1609930858
Name:MASSOUD AMINI M.D. INC.
Entity type:Organization
Organization Name:MASSOUD AMINI M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:AMINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-587-0145
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-0126
Mailing Address - Country:US
Mailing Address - Phone:323-587-0145
Mailing Address - Fax:323-587-6591
Practice Address - Street 1:7143 SEVILLE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4905
Practice Address - Country:US
Practice Address - Phone:323-587-0145
Practice Address - Fax:323-587-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0082600Medicaid
CAGR0082600Medicaid