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NPI Code Detail

MEDICARE: YASAMIN NANAZ GHIASI MD

MEDICARE: YASAMIN NANAZ GHIASI 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
1207KA0200XAllergy PhysicianA177332CA
2207KI0005XClinical & Laboratory Immunology (Allergy & Immunology) PhysicianA177332CA
3207K00000XAllergy & Immunology PhysicianA177332CA

General Provider Information

NPI Number : 1316409584
Entity Type Code : Individual
Provider Name (Legal Business Name) : YASAMIN NANAZ GHIASI MD
Provider Business Mailing Address
First Line : 5767 W CENTURY BLVD STE 400
Second Line :
City : LOS ANGELES
State : CA
Zip : 90045-5631
Country : US
Telephone Number : 310-301-8707
Fax Number :
Provider Business Practice Location Address
First Line : 8641 WILSHIRE BLVD STE 210
Second Line :
City : BEVERLY HILLS
State : CA
Zip : 90211-2920
Country : US
Telephone Number : 310-855-7002
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/04/2019
Last Update Date : 09/09/2024

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