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General NPI Number Information
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NPI Number | 1306041074
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Entity Type | Organization
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Legal Business Name | IRAJ NAZARIAN MD, INC MEDICAL CLINIC
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7136 PACIFIC BLVD SUITE # 225
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-4783
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Country | US
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Telephone | 310-991-4950
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Fax | 323-249-0469
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Provider Business Mailing Address
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Address Line | 641 NORTH DOHENY DRIVE
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City | BEVERLY HILLS
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State | CA
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Zip | 90210
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Country | US
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Telephone | 310-991-4950
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Fax | 323-249-0469
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Authorized Official
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Title or Position | OWNER
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Name | IRAJ NAZARIAN
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Credential | MD
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Telephone | 310-991-4950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | A43573
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License Number State | CA
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