MEDICARE: DR. FIROOZ PAK M.D.

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	207RN0300X	Nephrology Physician	A73904	CA
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	A73904	CA
3	207R00000X	Internal Medicine Physician	A73904	CA

General Provider Information

NPI Number	:	1568462364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FIROOZ PAK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 2350
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90267
Country	:	US
Telephone Number	:	310-488-4232
Fax Number	:

Provider Business Practice Location Address
First Line	:	8540 S SEPULVEDA BLVD
Second Line	:	STE 1100
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-3819
Country	:	US
Telephone Number	:	310-568-8938
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	08/22/2016

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Directions to “ DR. FIROOZ PAK M.D.” Practice Location

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