Provider Demographics
NPI:1326004078
Name:PAKOUR, MEADA (MD)
Entity Type:Individual
Prefix:DR
First Name:MEADA
Middle Name:
Last Name:PAKOUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:N/A
Other - Middle Name:
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3090 DRAGONFLY ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4818
Mailing Address - Country:US
Mailing Address - Phone:626-440-9195
Mailing Address - Fax:626-440-9196
Practice Address - Street 1:14608 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1621
Practice Address - Country:US
Practice Address - Phone:818-901-1600
Practice Address - Fax:818-901-1212
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76745207Q00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A767450Medicaid