Provider Demographics
NPI:1356498976
Name:PEYMAN GHASRI, MD, A PROF CORP.
Entity Type:Organization
Organization Name:PEYMAN GHASRI, MD, A PROF CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GHASRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-344-3376
Mailing Address - Street 1:18555 VENTURA BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-344-3376
Mailing Address - Fax:818-334-3396
Practice Address - Street 1:18555 VENTURA BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-344-3376
Practice Address - Fax:818-334-3396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83809207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA115192Medicare UPIN
CAI35545Medicare UPIN