MEDICARE: PAYAM JARRAHNEJAD MD A PROFESSIONAL MEDICAL CORPORATION

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	2086S0105X	Surgery of the Hand (Surgery) Physician	A89098	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A89098	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A89098	OTHER	CA	LICENCE

General Provider Information

NPI Number	:	1255566840
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAYAM JARRAHNEJAD MD A PROFESSIONAL MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	465 N ROXBURY DR STE 1017
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4213
Country	:	US
Telephone Number	:	310-993-3800
Fax Number	:	310-388-1617

Provider Business Practice Location Address
First Line	:	465 N ROXBURY DR STE 1017
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4213
Country	:	US
Telephone Number	:	310-993-3800
Fax Number	:	310-388-1617

Authorized Official
Title or Position	:	OWNER
Name	:	PAYAM JARRAHNEJAD
Credential	:	MD
Telephone Number	:	310-993-3800

Provider Enumeration Date	:	05/26/2009
Last Update Date	:	11/28/2018

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