Provider Demographics
NPI:1619020724
Name:IRADJ H NAZARIAN MD INC
Entity Type:Organization
Organization Name:IRADJ H NAZARIAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRADJ
Authorized Official - Middle Name:H
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-584-8818
Mailing Address - Street 1:7136 PACIFIC BLVD
Mailing Address - Street 2:STE 225
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-4783
Mailing Address - Country:US
Mailing Address - Phone:323-584-8818
Mailing Address - Fax:
Practice Address - Street 1:7136 PACIFIC BLVD
Practice Address - Street 2:STE 225
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-4783
Practice Address - Country:US
Practice Address - Phone:323-584-8818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43573208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0700622OtherCLIA
CA00A435731Medicaid
CAA85888Medicare UPIN
CAA43573AMedicare ID - Type Unspecified