Healthcare Provider Details

I. General information

NPI: 1457422065
Provider Name (Legal Business Name): JAHANGIR SHARIFI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 E CESAR E CHAVEZ AVE SUITE 560
LOS ANGELES CA
90033-2464
US

IV. Provider business mailing address

1701 E CESAR E CHAVEZ AVE SUITE 560
LOS ANGELES CA
90033-2464
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-0022
  • Fax: 323-488-9546
Mailing address:
  • Phone: 323-226-0022
  • Fax: 323-488-9546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA83156
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: