Healthcare Provider Details

I. General information

NPI: 1316102833
Provider Name (Legal Business Name): BABAK P AZAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2008
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9449 E. IMPERIAL HIGHWAY SUITE 206 ORCHARD MEDICAL OFFICE
DOWNEY CA
90242
US

IV. Provider business mailing address

9449 IMPERIAL HWY STE 206
DOWNEY CA
90242-2814
US

V. Phone/Fax

Practice location:
  • Phone: 562-657-2474
  • Fax:
Mailing address:
  • Phone: 973-609-2033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number14859
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number244893
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: