MEDICARE: PAYAM BENJAMIN NIKRAVESH DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	E4103	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	:	1437192200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAM BENJAMIN NIKRAVESH DPM

Provider Business Mailing Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE 600
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5501
Country	:	US
Telephone Number	:	323-782-8586
Fax Number	:	323-782-8528

Provider Business Practice Location Address
First Line	:	6404 WILSHIRE BLVD
Second Line	:	SUITE 600
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5501
Country	:	US
Telephone Number	:	323-782-8586
Fax Number	:	323-782-8528

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

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	07/08/2007

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Directions to “ PAYAM BENJAMIN NIKRAVESH DPM” Practice Location

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