Provider Demographics
NPI:1679040356
Name:KIAMEHR, JAVAD
Entity Type:Individual
Prefix:
First Name:JAVAD
Middle Name:
Last Name:KIAMEHR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4355 SEPULVEDA BLVD APT 331
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3927
Mailing Address - Country:US
Mailing Address - Phone:181-844-7664
Mailing Address - Fax:
Practice Address - Street 1:4355 SEPULVEDA BLVD APT 331
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-9140
Practice Address - Country:US
Practice Address - Phone:818-287-9247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT42007183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist