MEDICARE: EMOONAH INC

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	332B00000X	Durable Medical Equipment & Medical Supplies	102503	CA
2	3336L0003X	Long Term Care Pharmacy	PHY48785	CA
3	183500000X	Pharmacist	PHY48785	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861499527
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMOONAH INC

Provider Business Mailing Address
First Line	:	1015 S FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019
Country	:	US
Telephone Number	:	323-939-9490
Fax Number	:	323-939-8858

Provider Business Practice Location Address
First Line	:	1015 S FAIRFAX AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019
Country	:	US
Telephone Number	:	323-939-9490
Fax Number	:	323-939-8858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ROUZBEH JAVAHERIAN
Credential	:
Telephone Number	:	323-939-9490

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/10/2009

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Directions to “EMOONAH INC ” Practice Location

Language	Start Address	Practice Location

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