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General NPI Number Information
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NPI Number | 1710176094
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Entity Type | Organization
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Legal Business Name | PAYAM VAHEDIFAR MD INC
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Dates
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Enumeration Date | 10/23/2007
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Last Update Date | 04/11/2017
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Provider Practice Location Address
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Address Line | 16633 VENTURA BLVD SUITE 802
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City | ENCINO
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State | CA
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Zip | 91436-1824
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Country | US
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Telephone | 818-986-0200
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Fax | 818-986-4393
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Provider Business Mailing Address
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Address Line | 16633 VENTURA BLVD SUITE 802
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City | ENCINO
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State | CA
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Zip | 91436-1824
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Country | US
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Telephone | 818-986-0200
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Fax | 818-986-4393
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Authorized Official
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Title or Position | PHYSICIAN & OWNER
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Name | DR. PAYAM VAHEDIFAR
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Credential | M.D.
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Telephone | 310-795-5645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | A63617
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License Number State | CA
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