Provider Demographics
NPI:1124186002
Name:AZIZI, IRAJ (MD)
Entity Type:Individual
Prefix:
First Name:IRAJ
Middle Name:
Last Name:AZIZI
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 1:9200 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1319
Mailing Address - Country:US
Mailing Address - Phone:310-777-0444
Mailing Address - Fax:
Practice Address - Street 1:9200 WEST PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1319
Practice Address - Country:US
Practice Address - Phone:310-777-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43320207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A433200Medicaid
CAA43320Medicare ID - Type Unspecified
CAE21216Medicare UPIN