Provider Demographics
NPI:1053321901
Name:GHAFOURI, NEGAR (MD)
Entity Type:Individual
Prefix:
First Name:NEGAR
Middle Name:
Last Name:GHAFOURI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W. CENTURY BLVD
Mailing Address - Street 2:#400
Mailing Address - City:LOS ANGLES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-546-4599
Mailing Address - Fax:310-794-4941
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#265
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-206-6923
Practice Address - Fax:310-796-4941
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65438207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A654380Medicaid
CAWA65438AMedicare PIN
CA00A654380Medicaid