Healthcare Provider Details

I. General information

NPI: 1154947695
Provider Name (Legal Business Name): PRIME 5 MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST STE 540E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

PO BOX 6033
BEVERLY HILLS CA
90212-1033
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3000
  • Fax:
Mailing address:
  • Phone: 818-857-4466
  • Fax: 310-277-3659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PEJMAN DAVID SHAMEKH
Title or Position: PRESIDENT
Credential: MD
Phone: 818-857-4466