1306943626 NPI number — ARKADY MICHAILOVICH MASSEN M.D.

Table of content: ARKADY MICHAILOVICH MASSEN M.D. (NPI 1306943626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306943626 NPI number — ARKADY MICHAILOVICH MASSEN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MASSEN
Provider First Name:
ARKADY
Provider Middle Name:
MICHAILOVICH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306943626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19682 HESPERIAN BLVD STE 101A
Provider Second Line Business Mailing Address:
1393 SANTA RITA RD. #A
Provider Business Mailing Address City Name:
HAYWARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94541-4752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-783-0536
Provider Business Mailing Address Fax Number:
510-315-1103

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19682 HESPERIAN BLVD STE 101A
Provider Second Line Business Practice Location Address:
1393 SANTA RITA RD. #A
Provider Business Practice Location Address City Name:
HAYWARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94541-4752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-783-0536
Provider Business Practice Location Address Fax Number:
510-315-1103
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  A527260 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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