Healthcare Provider Details

I. General information

NPI: 1730271784
Provider Name (Legal Business Name): NAYIRI DOUDIKIAN-SCAFF, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST SUITE 168
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST SUITE 168
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-432-4600
  • Fax: 626-432-4607
Mailing address:
  • Phone: 626-432-4600
  • Fax: 626-432-4607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberA67181
License Number StateCA

VIII. Authorized Official

Name: DR. NAYIRI DOUDIKIAN-SCAFF
Title or Position: OWNER
Credential: M.D.
Phone: 626-432-4600