1306041074 NPI number — IRAJ NAZARIAN MD, INC MEDICAL CLINIC

Table of content: (NPI 1306041074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306041074 NPI number — IRAJ NAZARIAN MD, INC MEDICAL CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRAJ NAZARIAN MD, INC MEDICAL CLINIC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1306041074
Entity Type Code:
Organization
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:
641 NORTH DOHENY DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-991-4950
Provider Business Mailing Address Fax Number:
323-249-0469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7136 PACIFIC BLVD
Provider Second Line Business Practice Location Address:
SUITE # 225
Provider Business Practice Location Address City Name:
HUNTINGTON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90255-4783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-991-4950
Provider Business Practice Location Address Fax Number:
323-249-0469
Provider Enumeration Date:
06/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAZARIAN
Authorized Official First Name:
IRAJ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-991-4950

Provider Taxonomy Codes

  • Taxonomy code: 305S00000X , with the licence number:  A43573 , 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)

  • Identifier: A43573 . This is a "LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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