=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780958462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEJMAN BAHARI-NEJAD, D.O., A PROFESSIONAL MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2012
-----------------------------------------------------
Last Update Date | 07/21/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20829 VENTURA BLVD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-887-2787
-----------------------------------------------------
Fax | 310-286-0144
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20829 VENTURA BOULEVARD
-----------------------------------------------------
City | WOODLAND HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91364-2319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-887-2787
-----------------------------------------------------
Fax | 888-674-5810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PEJMAN BAHARI-NEJAD
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 818-887-2787
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A7938
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------