MEDICARE: ROKAY KAMYAR, M.D. 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	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1528057957
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROKAY KAMYAR, M.D. INC.

Provider Business Mailing Address
First Line	:	5119 GARFIELD ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5103
Country	:	US
Telephone Number	:	619-460-4055
Fax Number	:	619-460-5148

Provider Business Practice Location Address
First Line	:	5119 GARFIELD ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5103
Country	:	US
Telephone Number	:	619-460-4055
Fax Number	:	619-460-5148

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. KATHERINE HENDRICKSON
Credential	:
Telephone Number	:	619-460-4055

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/06/2011

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