Healthcare Provider Details

I. General information

NPI: 1134454226
Provider Name (Legal Business Name): JOSEPH PEJMAN ENAYATI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

IV. Provider business mailing address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax: 310-388-0185
Mailing address:
  • Phone: 310-651-6937
  • Fax: 310-388-0185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number20A13199
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number20A13199
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: