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General NPI Number Information
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NPI Number | 1053628511
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Entity Type | Organization
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Legal Business Name | PAYMAN VAHEDIFAR A PROFESSIONAL MEDICAL CORPORATION
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Dates
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Enumeration Date | 09/04/2010
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Last Update Date | 09/04/2010
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Provider Practice Location Address
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Address Line | 240 S LA CIENEGA BLVD SUITE 102
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3324
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Country | US
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Telephone | 310-288-0808
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Fax | 310-288-0080
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Provider Business Mailing Address
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Address Line | PO BOX 17173
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City | BEVERLY HILLS
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State | CA
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Zip | 90209-3173
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Country | US
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Telephone | 310-288-0808
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Fax | 310-288-0080
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAYMAN VAHEDIFAR
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Credential | M.D.
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Telephone | 310-288-0808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number |
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License Number State |
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