| Organization Name: | CASPIAN MEDICAL CLINIC, CORP |
| NPI Number: | 1275765612 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MAX MAHMOUD GHANNADI (OWNER) |
| Mailing Address: | 14103 Victory Blvd Suite 7 Van Nuys |
| State: | CA US |
| Postal Code: | 914011998 |
| Phone Number: | 8189940000 |
| Fax Number: | 8189882949 |
| NPI Enumeration Date: | 08/19/2009 |
| NPI Last Update Date: | 09/23/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A102618 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |