MEDICARE: ARMIN VISHTEH 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	207W00000X	Ophthalmology Physician	A69896	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114903317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARMIN VISHTEH MD

Provider Business Mailing Address
First Line	:	PO BOX 25166
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-0166
Country	:	US
Telephone Number	:	818-391-1058
Fax Number	:	818-391-1067

Provider Business Practice Location Address
First Line	:	2211 W MAGNOLIA BLVD
Second Line	:	STE 240
City	:	BURBANK
State	:	CA
Zip	:	91506-1753
Country	:	US
Telephone Number	:	818-391-1058
Fax Number	:	818-391-1067

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	11/06/2007

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