Ata Mazaheri MD Inc.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A79930 Issued in CA

Legal business name

ATA MAZAHERI MD INC.

Practice address

1560 E Chevy Chase Dr
Suite #450
Glendale, CA 91206-4197

Phone

(818) 246-3300

Fax

(818) 246-3305

NPI assigned

Jun 29, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ata Mazaheri, MDNPI 1164467239

Title

President

Phone

(818) 246-3300

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ata Mazaheri, MD

  • Surgery Physician
  • Glendale, CA
  • NPI 1164467239
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277769600000",
    "number": "1134430606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E. CHEVY CHASE DRIVE",
            "address_2": "SUITE #450",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "91206",
            "telephone_number": "818-246-3300",
            "fax_number": "818-246-3305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 E CHEVY CHASE DR",
            "address_2": "SUITE #450",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912064197",
            "telephone_number": "818-246-3300",
            "fax_number": "818-246-3305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATA MAZAHERI MD INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-29",
        "last_updated": "2010-06-29",
        "status": "A",
        "authorized_official_last_name": "MAZAHERI",
        "authorized_official_first_name": "ATA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "818-246-3300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A79930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Glendale, CA
• Providers in Glendale, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.