Healthcare Provider Details

I. General information

NPI: 1841349347
Provider Name (Legal Business Name): RAHA AKHAVAN, M.D., APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 02/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 W 3RD ST
LOS ANGELES CA
90057-1901
US

IV. Provider business mailing address

225 S LAKE AVE SUITE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 213-484-7111
  • Fax: 213-413-6338
Mailing address:
  • Phone: 626-795-6596
  • Fax: 626-795-8247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA69155
License Number StateCA

VIII. Authorized Official

Name: DR. RAHA AKHAVAN
Title or Position: PRESIDENT
Credential: M.D,
Phone: 310-892-9812