Healthcare Provider Details

I. General information

NPI: 1639163744
Provider Name (Legal Business Name): SAID K MOSTAFAVI M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date: 03/24/2006
Reactivation Date: 04/12/2006

III. Provider practice location address

2080 CENTURY PARK EAST SUITE 1401
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK EAST SUITE 1401
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-1881
  • Fax: 310-551-2984
Mailing address:
  • Phone: 310-551-1881
  • Fax: 310-551-2984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA43672
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: