Provider Demographics
NPI:1336293406
Name:DAYANI, POUYA NACHSHON (MD)
Entity Type:Individual
Prefix:DR
First Name:POUYA
Middle Name:NACHSHON
Last Name:DAYANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4886
Mailing Address - Country:US
Mailing Address - Phone:213-483-8810
Mailing Address - Fax:213-481-1503
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:380
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-483-8810
Practice Address - Fax:213-481-1503
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW3452OtherMEDICARE PTAN
CA1336293406OtherNPI
CAW3452OtherMEDICARE PTAN
CAW3452OtherMEDICARE PTAN