Healthcare Provider Details

I. General information

NPI: 1427476654
Provider Name (Legal Business Name): JUSTIN ZAGHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5665 WILSHIRE BLVD # 1609
LOS ANGELES CA
90036-3710
US

IV. Provider business mailing address

5665 WILSHIRE BLVD # 1609
LOS ANGELES CA
90036-3710
US

V. Phone/Fax

Practice location:
  • Phone: 818-618-6255
  • Fax:
Mailing address:
  • Phone: 818-618-6255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number90454
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME152272
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number327558
License Number StateLA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number311240
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT4294
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA140541
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: