MEDICARE: DR. MEADA PAKOUR 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	207Q00000X	Family Medicine Physician	A76745	CA
2	208000000X	Pediatrics Physician	A76745	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326004078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEADA PAKOUR M.D.

Provider Business Mailing Address
First Line	:	3090 DRAGONFLY ST
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91206-4818
Country	:	US
Telephone Number	:	626-440-9195
Fax Number	:	626-440-9196

Provider Business Practice Location Address
First Line	:	14608 VICTORY BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91411-1621
Country	:	US
Telephone Number	:	818-901-1600
Fax Number	:	818-901-1212

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

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	12/28/2007

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