MEDICARE: KAMAL BIJANPOUR 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	2084P0802X	Addiction Psychiatry Physician	A109162	CA
2	2084P0805X	Geriatric Psychiatry Physician	A109162	CA
3	2084P0800X	Psychiatry Physician	A109162	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A109162	OTHER	CA	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598903858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMAL BIJANPOUR M.D.

Provider Business Mailing Address
First Line	:	3605 LONG BEACH BLVD STE 304
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6018
Country	:	US
Telephone Number	:	310-559-5916
Fax Number	:	310-559-5466

Provider Business Practice Location Address
First Line	:	3605 LONG BEACH BLVD STE 304
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-6018
Country	:	US
Telephone Number	:	310-559-5916
Fax Number	:	310-559-5466

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

Provider Enumeration Date	:	01/25/2009
Last Update Date	:	05/21/2021

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Directions to “ KAMAL BIJANPOUR M.D.” Practice Location

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