Healthcare Provider Details

I. General information

NPI: 1063643732
Provider Name (Legal Business Name): NARAYAN PRABHU IYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2009
Last Update Date: 12/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD MAIL STOP #31, CHILDRENS HOSPITAL LOS ANGELES
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 W SUNSET BLVD MAIL STOP #31, CHILDRENS HOSPITAL LOS ANGELES
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 626-617-7043
  • Fax:
Mailing address:
  • Phone: 626-617-7043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57015958
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA129376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: