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General NPI Number Information
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NPI Number | 1053506402
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Entity Type | Organization
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Legal Business Name | POUYA BAHRAMI DO, INC
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 08/05/2016
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Provider Practice Location Address
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Address Line | 1245 WILSHIRE BLVD SUITE 611
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City | LOS ANGELES
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State | CA
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Zip | 90017-4810
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Country | US
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Telephone | 213-481-2200
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Fax |
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Provider Business Mailing Address
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Address Line | 1414 S GRAND AVE SUITE 100
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City | LOS ANGELES
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State | CA
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Zip | 90015-3067
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Country | US
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Telephone | 213-481-2200
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Fax | 213-481-7023
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. POUYA BAHRAMI
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Credential | D.O.
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Telephone | 213-481-2200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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