1457476426 NPI number — DOMINIC TASHI MUNASSI MD

Table of content: DOMINIC TASHI MUNASSI MD (NPI 1457476426)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457476426 NPI number — DOMINIC TASHI MUNASSI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNASSI
Provider First Name:
DOMINIC
Provider Middle Name:
TASHI
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MUNASSI
Provider Other First Name:
DOMINICK
Provider Other Middle Name:
TASHI
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1457476426
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9333 EAST IMPERIAL HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOWNEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-657-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9333 IMPERIAL HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOWNEY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90242-2812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-657-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/20/2007

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: 390200000X , with the licence number:  LL1694 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LL1694 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".