Provider Demographics
NPI:1528203999
Name:NASIMEH YAZDANI, MD, PC
Entity Type:Organization
Organization Name:NASIMEH YAZDANI, MD, PC
Other - Org Name:SEASIDE MEDICAL PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MAHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:YAZDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-393-5000
Mailing Address - Street 1:2319 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5801
Mailing Address - Country:US
Mailing Address - Phone:310-393-5000
Mailing Address - Fax:310-393-5007
Practice Address - Street 1:2319 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5801
Practice Address - Country:US
Practice Address - Phone:310-393-5000
Practice Address - Fax:310-393-5007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2022-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90937207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty