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General NPI Number Information
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NPI Number | 1093941171
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Entity Type | Individual
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Provider Name | PEYMAN KABOLIZADEH
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Gender | Male
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 18111 BROOKHURST ST STE LL0300
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-6728
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Country | US
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Telephone | 714-962-7100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 844945
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City | LOS ANGELES
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State | CA
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Zip | 90084-4945
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Country | US
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Telephone |
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A152224
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License Number State | CA
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