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General NPI Number Information
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NPI Number | 1063789246
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Entity Type | Individual
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Provider Name | PEDRAM YOUABIAN O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/16/2011
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Last Update Date | 10/27/2021
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Provider Practice Location Address
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Address Line | 21851 VICTORY BLVD
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City | CANOGA PARK
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State | CA
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Zip | 91304
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Country | US
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Telephone | 818-992-7283
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Fax |
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Provider Business Mailing Address
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Address Line | 352 S DOHENY DR APT 1
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-3532
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Country | US
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Telephone | 818-992-7283
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 14168TLG
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License Number State | CA
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