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General NPI Number Information
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NPI Number | 1225815764
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Entity Type | Organization
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Legal Business Name | DR JASON NIKZAD INC
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Dates
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Enumeration Date | 09/08/2023
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Last Update Date | 09/08/2023
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Provider Practice Location Address
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Address Line | 8405 PERSHING DR STE 206
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7860
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Country | US
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Telephone | 310-525-6064
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Fax |
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Provider Business Mailing Address
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Address Line | 8405 PERSHING DR STE 206
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-7860
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Country | US
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Telephone | 310-525-6064
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Fax |
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Authorized Official
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Title or Position | OWNER / PRESIDENT / DIRECTOR
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Name | JASON NIKZAD
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Credential | DO
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Telephone | 310-525-6064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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