Healthcare Provider Details

I. General information

NPI: 1255566840
Provider Name (Legal Business Name): PAYAM JARRAHNEJAD MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 11/28/2018
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 DR STE 1017
BEVERLY HILLS CA
90210-4213
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 TaxonomyN
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberA89098
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA89098
License Number StateCA

VIII. Authorized Official

Name: PAYAM JARRAHNEJAD
Title or Position: OWNER
Credential: MD
Phone: 310-993-3800