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General NPI Number Information
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NPI Number | 1124264635
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Entity Type | Organization
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Legal Business Name | AVICCENNA MEDICAL GROUP
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 435 N BEDFORD DR SUITE # 312
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4321
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Country | US
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Telephone | 310-858-1800
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Fax |
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Provider Business Mailing Address
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Address Line | 3392 MOTOR AVE
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City | LOS ANGELES
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State | CA
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Zip | 90034-3712
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Country | US
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Telephone | 310-858-1800
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SEYED FARHAD N CHIMEH
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Credential | MD
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Telephone | 310-858-1800
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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 | A100198
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License Number State | CA
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