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General NPI Number Information
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NPI Number | 1134148190
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Entity Type | Organization
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Legal Business Name | FOREVER YOUNG, INC.
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 6333 WILSHIRE BLVD SUITE 409
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City | LOS ANGELES
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State | CA
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Zip | 90048-5702
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Country | US
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Telephone | 323-653-7700
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Fax | 323-653-6409
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Provider Business Mailing Address
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Address Line | 6333 WILSHIRE BLVD SUITE 409
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City | LOS ANGELES
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State | CA
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Zip | 90048-5702
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Country | US
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Telephone | 323-653-7700
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Fax | 323-653-6409
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Authorized Official
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Title or Position | OWNER
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Name | AFSHIN DAVID RAHIMI
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Credential | M.D.
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Telephone | 323-653-7700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | A63668
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License Number State | CA
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