Provider Demographics
NPI:1649381039
Name:POURAT, BIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:POURAT
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 1:9001 WILSHIRE BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1841
Mailing Address - Country:US
Mailing Address - Phone:310-734-7303
Mailing Address - Fax:310-943-3336
Practice Address - Street 1:9001 WILSHIRE BLVD STE 308
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211
Practice Address - Country:US
Practice Address - Phone:310-734-7303
Practice Address - Fax:310-943-3336
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33770173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27249Medicare UPIN