Healthcare Provider Details

I. General information

NPI: 1023339496
Provider Name (Legal Business Name): AMIR ALI RAHNEMAI AZAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 123
PASADENA CA
91102-0123
US

IV. Provider business mailing address

PO BOX 123
PASADENA CA
91102-0123
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5430
  • Fax:
Mailing address:
  • Phone: 310-571-5430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA163254
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA163254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: