Provider Demographics
NPI:1548603897
Name:YAGHOOBIAN, PAYAM (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:YAGHOOBIAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1927 MALCOLM AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4744
Mailing Address - Country:US
Mailing Address - Phone:310-422-6806
Mailing Address - Fax:
Practice Address - Street 1:1927 MALCOLM AVE APT 5
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4744
Practice Address - Country:US
Practice Address - Phone:310-422-6806
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA68094183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist