Healthcare Provider Details

I. General information

NPI: 1770108672
Provider Name (Legal Business Name): PEGAH PANIRIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8635 W 3RD ST STE 880W
LOS ANGELES CA
90048-6155
US

IV. Provider business mailing address

8635 W 3RD ST STE 880W
LOS ANGELES CA
90048-6155
US

V. Phone/Fax

Practice location:
  • Phone: 213-947-4938
  • Fax: 310-289-1526
Mailing address:
  • Phone: 213-947-4938
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberEL6959
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: