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NPI Code Detail

MEDICARE: MARK GANJIANPOUR M.D.

MEDICARE: MARK GANJIANPOUR 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
1207XX0005XSports Medicine (Orthopaedic Surgery) PhysicianA71208CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00068539OTHERCARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2346434300OTHERCADEPT OF LABOR
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447229570
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK GANJIANPOUR M.D.
Provider Business Mailing Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number : 310-358-2453
Provider Business Practice Location Address
First Line : 6330 SAN VICENTE BLVD
Second Line : SUITE 310
City : LOS ANGELES
State : CA
Zip : 90048-5425
Country : US
Telephone Number : 310-855-0751
Fax Number : 310-358-2453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2006
Last Update Date : 01/29/2014

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