Provider Demographics
NPI:1194028233
Name:PAVILLION ASC INC.
Entity Type:Organization
Organization Name:PAVILLION ASC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NAJAFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-514-2511
Mailing Address - Street 1:P.O. BOX 9225
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91372
Mailing Address - Country:US
Mailing Address - Phone:310-514-2511
Mailing Address - Fax:310-514-2449
Practice Address - Street 1:28901 S. WESTERN AVENUE #127
Practice Address - Street 2:
Practice Address - City:RANCHO PALOS VEREDES
Practice Address - State:CA
Practice Address - Zip Code:90275
Practice Address - Country:US
Practice Address - Phone:310-514-2511
Practice Address - Fax:310-514-2449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37763207ND0900X, 208200000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty