Provider Demographics
NPI:1275030009
Name:M PAKOUR MD INC
Entity Type:Organization
Organization Name:M PAKOUR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEADA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAKOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-913-0738
Mailing Address - Street 1:3671 W 6TH ST STE B
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3026
Mailing Address - Country:US
Mailing Address - Phone:213-375-7511
Mailing Address - Fax:213-375-7232
Practice Address - Street 1:3671 W 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3026
Practice Address - Country:US
Practice Address - Phone:213-375-7511
Practice Address - Fax:213-375-7232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76745261QM1300X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty