Provider Demographics
NPI:1346977501
Name:BOZORGNIA MD MEDICAL SERVICES
Entity Type:Organization
Organization Name:BOZORGNIA MD MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FARSHID
Authorized Official - Middle Name:
Authorized Official - Last Name:BOZORGNIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-272-9062
Mailing Address - Street 1:1792 AMARELLE ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-5994
Mailing Address - Country:US
Mailing Address - Phone:734-272-9062
Mailing Address - Fax:
Practice Address - Street 1:14150 CULVER DR STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0322
Practice Address - Country:US
Practice Address - Phone:734-272-9062
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-06
Last Update Date:2022-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty