Healthcare Provider Details

I. General information

NPI: 1316177280
Provider Name (Legal Business Name): POUYA SHAFIPOUR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 SAWTELLE BLVD STE 130
LOS ANGELES CA
90025-7072
US

IV. Provider business mailing address

1950 SAWTELLE BLVD STE 130
LOS ANGELES CA
90025-7072
US

V. Phone/Fax

Practice location:
  • Phone: 310-996-9355
  • Fax: 310-494-0061
Mailing address:
  • Phone: 310-996-9355
  • Fax: 310-494-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. POUYA SHAFIPOUR
Title or Position: INCORPORATOR
Credential: MD
Phone: 310-996-9355