Healthcare Provider Details

I. General information

NPI: 1316110455
Provider Name (Legal Business Name): KIARASH PAYDAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 10/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 S CENTRAL AVE
GLENDALE CA
91204-2508
US

IV. Provider business mailing address

PO BOX 5486
ORANGE CA
92863-5486
US

V. Phone/Fax

Practice location:
  • Phone: 818-502-1900
  • Fax: 818-502-4738
Mailing address:
  • Phone: 818-550-0900
  • Fax: 303-953-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA119688
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number53787
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: