Healthcare Provider Details

I. General information

NPI: 1396765673
Provider Name (Legal Business Name): AFSHIN SEAN JAVAHERIAN D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 05/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8737 BEVERLY BLVD STE 103
WEST HOLLYWOOD CA
90048-1835
US

IV. Provider business mailing address

8737 BEVERLY BLVD STE 103
WEST HOLLYWOOD CA
90048-1835
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-3700
  • Fax: 310-657-3701
Mailing address:
  • Phone: 310-657-3700
  • Fax: 310-657-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: