Healthcare Provider Details

I. General information

NPI: 1699360164
Provider Name (Legal Business Name): VAHEDIFAR PIROUZ MEDICAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 03/05/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 W OLYMPIC BLVD STE 209
LOS ANGELES CA
90036-4663
US

IV. Provider business mailing address

PO BOX 17173
BEVERLY HILLS CA
90209-3173
US

V. Phone/Fax

Practice location:
  • Phone: 310-288-0808
  • Fax:
Mailing address:
  • Phone: 310-288-0808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAYMAN VAHEDIFAR
Title or Position: PARTNER
Credential: MD
Phone: 310-288-0808