MEDICARE: AFSHIN AKHAVAN SAFA MD

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	2085R0001X	Radiation Oncology Physician	A60934	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00A609340	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1790789287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AFSHIN AKHAVAN SAFA MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-825-9771
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MEDICAL PLZ
Second Line	:	SUITE B265
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-825-9771
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	02/25/2014

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