Healthcare Provider Details

I. General information

NPI: 1295955524
Provider Name (Legal Business Name): AZIZEH ASGARI, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 S GLENDALE AVE SUITE 406
GLENDALE CA
91205-5612
US

IV. Provider business mailing address

16661 VENTURA BLVD SUITE 309
ENCINO CA
91436-1914
US

V. Phone/Fax

Practice location:
  • Phone: 818-241-0016
  • Fax: 818-241-0407
Mailing address:
  • Phone: 818-995-6046
  • Fax: 818-995-5726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA48989
License Number StateCA

VIII. Authorized Official

Name: DR. AZIZEH ASGARIPOUR
Title or Position: PRESIDENT
Credential: MD
Phone: 818-995-6046