Provider Demographics
NPI:1497770432
Name:NEJAT, ALBERT A (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:NEJAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-6807
Mailing Address - Country:US
Mailing Address - Phone:310-204-2300
Mailing Address - Fax:310-204-0444
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:SUITE 600
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-6807
Practice Address - Country:US
Practice Address - Phone:310-204-2300
Practice Address - Fax:310-204-0444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4400213E00000X, 213EP1101X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4400CMedicare PIN
CAU74842Medicare UPIN
CA4690500002Medicare NSC