Provider Demographics
NPI:1508843699
Name:AKHANJEE, NARGIS R (MD)
Entity Type:Individual
Prefix:
First Name:NARGIS
Middle Name:R
Last Name:AKHANJEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NARGIS
Other - Middle Name:
Other - Last Name:ROWSHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2105 BEVERLY BLVD
Mailing Address - Street 2:STE 217A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-483-5430
Mailing Address - Fax:
Practice Address - Street 1:2105 BEVERLY BLVD
Practice Address - Street 2:STE 217A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-483-5430
Practice Address - Fax:213-483-4151
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42277207Q00000X
DEC10007182207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42277AMedicare PIN
CAE01658Medicare UPIN