Provider Demographics
NPI:1679041966
Name:KEYVANI, AZIN (PHAMD)
Entity Type:Individual
Prefix:
First Name:AZIN
Middle Name:
Last Name:KEYVANI
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10654 EASTBORNE AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5966
Mailing Address - Country:US
Mailing Address - Phone:310-980-4256
Mailing Address - Fax:
Practice Address - Street 1:6500 WILSHIRE BLVD STE 2240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4935
Practice Address - Country:US
Practice Address - Phone:310-385-3457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77726183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist