MEDICARE: DR. PAYMAN VAHEDIFAR 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	207RN0300X	Nephrology Physician	A62526	CA

General Provider Information

NPI Number	:	1275522096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAYMAN VAHEDIFAR M.D

Provider Business Mailing Address
First Line	:	8635 W 3RD ST
Second Line	:	STE# 865W
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6101
Country	:	US
Telephone Number	:	310-659-1654
Fax Number	:

Provider Business Practice Location Address
First Line	:	8635 W 3RD ST
Second Line	:	STE# 865W
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-6101
Country	:	US
Telephone Number	:	310-659-1654
Fax Number	:

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

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	07/08/2007

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