Provider Demographics
NPI:1073520920
Name:EMAD, BEHZAD (MD)
Entity Type:Individual
Prefix:
First Name:BEHZAD
Middle Name:
Last Name:EMAD
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 1:11693 SAN VICENTE BLVD
Mailing Address - Street 2:PMB 222
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049
Mailing Address - Country:US
Mailing Address - Phone:323-932-9880
Mailing Address - Fax:323-932-9829
Practice Address - Street 1:5757 WILSHIRE BLVD
Practice Address - Street 2:SUITE 660
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-5810
Practice Address - Country:US
Practice Address - Phone:323-932-9880
Practice Address - Fax:323-932-9829
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0557272081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A557270Medicaid
CAW16980Medicare ID - Type Unspecified
CA00A557270Medicaid