Provider Demographics
NPI:1609914290
Name:KERENDIAN, PAYAM EZRA (DO)
Entity Type:Individual
Prefix:
First Name:PAYAM
Middle Name:EZRA
Last Name:KERENDIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8484 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 670
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3201
Mailing Address - Country:US
Mailing Address - Phone:310-859-1077
Mailing Address - Fax:323-782-9432
Practice Address - Street 1:8484 WILSHIRE BLVD
Practice Address - Street 2:STE 670
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3233
Practice Address - Country:US
Practice Address - Phone:310-859-1077
Practice Address - Fax:323-782-9432
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8382207Q00000X, 2083P0901X, 207QB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine