MEDICARE: PAYAM HEDAYATY

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	183500000X	Pharmacist	INT37338	CA

General Provider Information

NPI Number	:	1629506530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAYAM HEDAYATY

Provider Business Mailing Address
First Line	:	12015 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1201
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12015 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1201
Country	:	US
Telephone Number	:	310-479-6500
Fax Number	:

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

Provider Enumeration Date	:	05/23/2017
Last Update Date	:	05/23/2017

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Directions to “ PAYAM HEDAYATY ” Practice Location

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