1992840680 NPI number — JAVID TAVARI, D.O., INC.

Table of content: (NPI 1992840680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992840680 NPI number — JAVID TAVARI, D.O., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAVID TAVARI, D.O., INC.
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:
1992840680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11645 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 745
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90025-1708
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-696-0100
Provider Business Mailing Address Fax Number:
310-696-0700

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11645 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 745
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-1708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-696-0100
Provider Business Practice Location Address Fax Number:
310-696-0700
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TAVARI
Authorized Official First Name:
JAVID
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-696-0100

Provider Taxonomy Codes

  • Taxonomy code: 207QS0010X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 20A6273 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RS0010X , with the licence number: 20A6273 , 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: 020A62731 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020A62731 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020A62730 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FNP2021 . This is a "OSTEOPATHIC MEDICAL BOARD OF CALIFORNIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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