Provider Demographics
NPI:1063647865
Name:BADIEI, PEJMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PEJMAN
Middle Name:
Last Name:BADIEI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 N MOORPARK RD # 291
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5129
Mailing Address - Country:US
Mailing Address - Phone:949-241-1652
Mailing Address - Fax:
Practice Address - Street 1:1534 N MOORPARK RD # 291
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5129
Practice Address - Country:US
Practice Address - Phone:949-241-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-22
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA121014207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine