Healthcare Provider Details

I. General information

NPI: 1699118752
Provider Name (Legal Business Name): KAMAL BIJANPOUR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3605 LONG BEACH BLVD STE 304
LONG BEACH CA
90807-6018
US

IV. Provider business mailing address

3000 S ROBERTSON BLVD SUITE 270
LOS ANGELES CA
90034-3158
US

V. Phone/Fax

Practice location:
  • Phone: 310-559-5916
  • Fax: 310-559-5466
Mailing address:
  • Phone: 310-559-5916
  • Fax: 310-559-5466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282NC0060X
TaxonomyCritical Access Hospital
License NumberA109162
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License NumberA109162
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberA109162
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberA109162
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License NumberA109162
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberA109162
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code315D00000X
TaxonomyInpatient Hospice
License NumberA109162
License Number StateCA
# 10
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberA109162
License Number StateCA

VIII. Authorized Official

Name: KAMAL BIJANPOUR
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 310-801-5473