Healthcare Provider Details

I. General information

NPI: 1710376926
Provider Name (Legal Business Name): BABAK PEZESHKI MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2011 WILSHIRE BLVD
LOS ANGELES CA
90057-3503
US

IV. Provider business mailing address

2007 WILSHIRE BLVD STE 300
LOS ANGELES CA
90057-3506
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-2700
  • Fax:
Mailing address:
  • Phone: 213-413-2700
  • Fax: 213-413-6722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA150504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: