Healthcare Provider Details

I. General information

NPI: 1225220205
Provider Name (Legal Business Name): NAVA YEGANEH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 05/31/2023
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 16TH ST STE 204
SANTA MONICA CA
90404-1240
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA99936
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License NumberA99936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: