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General NPI Number Information
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NPI Number | 1346306321
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Entity Type | Organization
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Legal Business Name | FIROOZ PAK MD INC
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 8540 S SEPULVEDA BLVD 1100
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City | LOS ANGELES
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State | CA
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Zip | 90045-3807
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Country | US
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Telephone | 310-568-8938
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Fax | 310-665-9004
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Provider Business Mailing Address
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Address Line | 3950 VIA DOLCE 509
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5289
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Country | US
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Telephone | 310-568-8938
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Fax | 310-665-9004
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FIROOZ PAK
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Credential | M.D.
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Telephone | 310-568-8938
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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 | A73904
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License Number State | CA
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