MEDICARE: DR. MOJTABA OLYAIE 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	207U00000X	Nuclear Medicine Physician	A56351	CA

General Provider Information

NPI Number	:	1659015360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOJTABA OLYAIE M.D

Provider Business Mailing Address
First Line	:	20891 KELVIN PL
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6725
Country	:	US
Telephone Number	:	818-422-2343
Fax Number	:

Provider Business Practice Location Address
First Line	:	11301 WILSHIRE BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90073-1003
Country	:	US
Telephone Number	:	310-478-3711
Fax Number	:

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

Provider Enumeration Date	:	04/27/2022
Last Update Date	:	12/12/2025

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