Healthcare Provider Details

I. General information

NPI: 1942465232
Provider Name (Legal Business Name): JANET VAFAIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2008
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10921 WILSHIRE BLVD STE 800
LOS ANGELES CA
90024-4003
US

IV. Provider business mailing address

10647 ASHTON AVE UNIT 302
LOS ANGELES CA
90024-5288
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-5459
  • Fax: 310-456-5469
Mailing address:
  • Phone: 310-456-5459
  • Fax: 310-456-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA90755
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA90755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: