MEDICARE: PRIME 5 MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C4602133	OTHER	CA	BUSINESS LICENSE

General Provider Information

NPI Number	:	1154947695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME 5 MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	PO BOX 6033
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-1033
Country	:	US
Telephone Number	:	818-857-4466
Fax Number	:	310-277-3659

Provider Business Practice Location Address
First Line	:	8631 W 3RD ST STE 540E
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5901
Country	:	US
Telephone Number	:	310-423-3000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PEJMAN DAVID SHAMEKH
Credential	:	MD
Telephone Number	:	818-857-4466

Provider Enumeration Date	:	06/21/2020
Last Update Date	:	04/27/2026

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