MEDICARE: DR. PEYMAN SOLIEMANZADEH 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	207YS0123X	Facial Plastic Surgery Physician	A90211	CA

General Provider Information

NPI Number	:	1144215849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEYMAN SOLIEMANZADEH M.D.

Provider Business Mailing Address
First Line	:	9201 W SUNSET BLVD
Second Line	:	M130
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3701
Country	:	US
Telephone Number	:	310-276-6800
Fax Number	:	310-276-6801

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD
Second Line	:	M130
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3701
Country	:	US
Telephone Number	:	310-276-6800
Fax Number	:	310-276-6801

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

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	10/04/2007

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