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General NPI Number Information
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NPI Number | 1679041966
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Entity Type | Individual
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Provider Name | AZIN KEYVANI PHAMD
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Gender | Female
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Dates
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Enumeration Date | 11/05/2018
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Last Update Date | 11/06/2018
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Provider Practice Location Address
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Address Line | 6500 WILSHIRE BLVD STE 2240
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City | LOS ANGELES
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State | CA
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Zip | 90048-4935
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Country | US
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Telephone | 310-385-3457
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Fax |
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Provider Business Mailing Address
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Address Line | 10654 EASTBORNE AVE APT 102
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City | LOS ANGELES
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State | CA
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Zip | 90024-5966
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Country | US
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Telephone | 310-980-4256
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 77726
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License Number State | CA
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