Provider Demographics
NPI:1235366584
Name:OMIDVAR, YASAMAN (MD)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:OMIDVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 GREEN VALLEY CIR STE 405
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6971
Mailing Address - Country:US
Mailing Address - Phone:424-266-7474
Mailing Address - Fax:310-596-8268
Practice Address - Street 1:5901 GREEN VALLEY CIR STE 405
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6971
Practice Address - Country:US
Practice Address - Phone:424-266-7474
Practice Address - Fax:310-596-8268
Is Sole Proprietor?:No
Enumeration Date:2009-06-14
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA114462207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine