Healthcare Provider Details

I. General information

NPI: 1144279514
Provider Name (Legal Business Name): PAYAM ROBERT YASHAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PAYAM ROBERT YASHAR MD INC

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST SUITE 1050W
LOS ANGELES CA
90048-6101
US

IV. Provider business mailing address

PO BOX 516
BEVERLY HILLS CA
90213
US

V. Phone/Fax

Practice location:
  • Phone: 310-556-2020
  • Fax: 310-788-8477
Mailing address:
  • Phone: 310-556-2020
  • Fax: 310-788-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA66101
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA66101
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA66101
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: