Physician Compare National (NPI:1164447959)

HEALTHCARE PROVIDER: SIAMAK STEPHEN MARZBAN M.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1164447959
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	1153589171
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20120222000770
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	MARZBAN
	Individual professional last name
Provider First Name	SIAMAK
	Individual professional first name
Provider Middle Name	STEPHEN
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	OTHER
	Individual professional's medical school
Graduation Year	1979
	Individual professional's medical school graduation year
Primary Specialty	INTERNAL MEDICINE
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	2403 S MORAY AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 2B
	Group Practice or individual's line 2 address
City	SAN PEDRO
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	907324358
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050078
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	PROVIDENCE LITTLE CO OF MARY MED CTR SAN PEDRO
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y