=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124174560
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SEPEHR NOWFAR M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2007
-----------------------------------------------------
Last Update Date | 10/04/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15111 WHITTIER BLVD STE 390
-----------------------------------------------------
City | WHITTIER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90603-3301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-320-8281
-----------------------------------------------------
Fax | 562-861-2133
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 575 E HARDY ST SUITE 215
-----------------------------------------------------
City | INGLEWOOD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90301-4036
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-673-3333
-----------------------------------------------------
Fax | 310-673-1714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208800000X
-----------------------------------------------------
Taxonomy Name | Urology Physician
-----------------------------------------------------
License Number | A97699
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------