MEDICARE: ROYA YAZDANI

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	171100000X	Acupuncturist	AC 4348	CA

General Provider Information

NPI Number	:	1750633491
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROYA YAZDANI

Provider Business Mailing Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2500
Country	:	US
Telephone Number	:	310-481-0045
Fax Number	:

Provider Business Practice Location Address
First Line	:	12340 SANTA MONICA BLVD
Second Line	:	SUITE 302
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-2500
Country	:	US
Telephone Number	:	310-481-0045
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ROYA YAZDANI
Credential	:	L.AC.
Telephone Number	:	310-481-0045

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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