Provider Demographics
NPI:1326270422
Name:FAMINI, POUYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:POUYAN
Middle Name:
Last Name:FAMINI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15503 VENTURA BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3145
Mailing Address - Country:US
Mailing Address - Phone:818-461-8148
Mailing Address - Fax:818-461-8106
Practice Address - Street 1:15503 VENTURA BLVD STE 170
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3145
Practice Address - Country:US
Practice Address - Phone:818-461-8148
Practice Address - Fax:818-461-8106
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2019-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114529207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine