MEDICARE: DR. MICHAEL JAVAHERI M.D.

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	A94767	CA
2	207WX0107X	Retina Specialist (Ophthalmology) Physician	A94767	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1124298575	OTHER	CA	NPI

General Provider Information

NPI Number	:	1124298575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JAVAHERI M.D.

Provider Business Mailing Address
First Line	:	9735 WILSHIRE BLVD STE 219
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2110
Country	:	US
Telephone Number	:	310-858-6569
Fax Number	:	310-858-3922

Provider Business Practice Location Address
First Line	:	9735 WILSHIRE BLVD STE 219
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2110
Country	:	US
Telephone Number	:	310-858-6569
Fax Number	:	310-858-3922

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

Provider Enumeration Date	:	02/29/2008
Last Update Date	:	12/06/2023

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