Healthcare Provider Details

I. General information

NPI: 1588823181
Provider Name (Legal Business Name): PAYAM JARRAHNEJAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 11/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR STE 1017
BEVERLY HILLS CA
90210-4213
US

IV. Provider business mailing address

465 N ROXBURY DRIVE SUITE 1017
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-993-3800
  • Fax: 310-388-1617
Mailing address:
  • Phone: 310-993-3800
  • Fax: 310-388-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberA89098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: