Provider Demographics
NPI:1225815764
Name:DR JASON NIKZAD INC
Entity Type:Organization
Organization Name:DR JASON NIKZAD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NIKZAD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-525-6064
Mailing Address - Street 1:8405 PERSHING DR STE 206
Mailing Address - Street 2:
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-7860
Mailing Address - Country:US
Mailing Address - Phone:310-525-6064
Mailing Address - Fax:
Practice Address - Street 1:8405 PERSHING DR STE 206
Practice Address - Street 2:
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-7860
Practice Address - Country:US
Practice Address - Phone:310-525-6064
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty