MEDICARE: DR. YAMIN ZAKARIAI MIANDOB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	C50436	CA

General Provider Information

NPI Number	:	1063540961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YAMIN ZAKARIAI MIANDOB MD

Provider Business Mailing Address
First Line	:	234 S GALE DR
Second Line	:	SUITE 201
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3481
Country	:	US
Telephone Number	:	323-651-0421
Fax Number	:

Provider Business Practice Location Address
First Line	:	820 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4010
Country	:	US
Telephone Number	:	323-651-0421
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/09/2007

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