Provider Demographics
NPI:1265672794
Name:PEJMAN D SHAMEKH, M.D., INC
Entity Type:Organization
Organization Name:PEJMAN D SHAMEKH, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEJMAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SHAMEKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-279-9328
Mailing Address - Street 1:PO BOX 6033
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1033
Mailing Address - Country:US
Mailing Address - Phone:310-788-0074
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:310-788-0074
Practice Address - Fax:310-277-3659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty