Healthcare Provider Details

I. General information

NPI: 1306351895
Provider Name (Legal Business Name): PAYAM EBIZADEH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2017
Last Update Date: 09/12/2025
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1233 S WESTGATE AVE APT 307
LOS ANGELES CA
90025-6792
US

IV. Provider business mailing address

1233 S WESTGATE AVE APT 307
LOS ANGELES CA
90025-6792
US

V. Phone/Fax

Practice location:
  • Phone: 267-496-9056
  • Fax:
Mailing address:
  • Phone: 267-496-9056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number109881
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA109881
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: