Healthcare Provider Details

I. General information

NPI: 1528254380
Provider Name (Legal Business Name): S K MOSTAFAVI MD FCCP A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 W OLYMPIC BLVD STE 617
LOS ANGELES CA
90064-3804
US

IV. Provider business mailing address

11500 W OLYMPIC BLVD STE 617
LOS ANGELES CA
90064-3804
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-1881
  • Fax: 310-551-2984
Mailing address:
  • Phone: 310-551-1881
  • Fax: 310-551-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA43672
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SAID MOSTAFAVI
Title or Position: MD
Credential: MD
Phone: 310-551-1881