Basic Information
| Provider Information | |||||||||
| NPI: | 1073679049 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSOUDIAN | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | TAGHI | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1713 VIA ZURITA | ||||||||
| Address2: | |||||||||
| City: | PALOS VERDES ESTATES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902741964 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103755149 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3640 LOMITA BLVD | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103758088 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | A39317 | CA | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085N0904X | A39317 | CA | X | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology |
ID Information
| ID | Type | State | Issuer | Description | A39317 | 01 | CA | MEDICAL LICENSE | OTHER |