=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841325099
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEIMAN BERDJIS MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/21/2007
-----------------------------------------------------
Last Update Date | 08/30/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6222 WILSHIRE BLVD STE 303
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90048-5193
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-525-1999
-----------------------------------------------------
Fax | 323-525-1991
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5349
-----------------------------------------------------
City | BEVERLY HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90209-5349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-525-1999
-----------------------------------------------------
Fax | 323-525-1991
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PEIMAN BERDJIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-277-2999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A067173
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------