Provider Demographics
NPI:1639163744
Name:MOSTAFAVI, SAID K (MD,)
Entity Type:Individual
Prefix:
First Name:SAID
Middle Name:K
Last Name:MOSTAFAVI
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK EAST
Mailing Address - Street 2:SUITE 1401
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-551-1881
Mailing Address - Fax:310-551-2984
Practice Address - Street 1:2080 CENTURY PARK EAST
Practice Address - Street 2:SUITE 1401
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-551-1881
Practice Address - Fax:310-551-2984
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2021-08-04
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-04-12
Provider Licenses
StateLicense IDTaxonomies
CAA43672207RS0012X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A436720OtherBLUECROSS/BLUESHIELD
CA00A436721Medicaid
CAWA43672EMedicare PIN
CA00A436721Medicaid