Healthcare Provider Details

I. General information

NPI: 1568462364
Provider Name (Legal Business Name): FIROOZ PAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 08/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8540 S SEPULVEDA BLVD STE 1100
LOS ANGELES CA
90045-3819
US

IV. Provider business mailing address

PO BOX 2350
MANHATTAN BEACH CA
90267
US

V. Phone/Fax

Practice location:
  • Phone: 310-568-8938
  • Fax:
Mailing address:
  • Phone: 310-488-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA73904
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA73904
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA73904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: