Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 20A6170 | CA |
N | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 20A6170 | CA |
NPI | 1386839249 |
---|---|
Provider Name | Dr. Mohsen Tavoussi |
First Address | Whittier, CA 90605-1817 |
Second Address | Whittier, CA 90605-1817 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2007 |
Last Update Date | 22/06/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E88349 | (02) | CA |