MEDICARE: MOFTAKHAR PARHAM, MD

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	208D00000X	General Practice Physician	A112460	CA

General Provider Information

NPI Number	:	1962718825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOFTAKHAR PARHAM, MD

Provider Business Mailing Address
First Line	:	3240 WILSHIRE BLVD
Second Line	:	SUITE 270
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	213-437-9869
Fax Number	:	213-365-4080

Provider Business Practice Location Address
First Line	:	3240 WILSHIRE BLVD
Second Line	:	SUITE 270
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1502
Country	:	US
Telephone Number	:	213-427-9869
Fax Number	:	213-365-0480

Authorized Official
Title or Position	:	MEDICAL DOCTOR
Name	:	MOFTAKHAR PARHAM
Credential	:	MD
Telephone Number	:	213-427-9869

Provider Enumeration Date	:	08/29/2010
Last Update Date	:	08/29/2010

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