Provider Demographics
NPI:1679650386
Name:YOUSEFI, KEYVAN (MD)
Entity Type:Individual
Prefix:
First Name:KEYVAN
Middle Name:
Last Name:YOUSEFI
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:PO BOX 10191
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-3191
Mailing Address - Country:US
Mailing Address - Phone:310-888-7737
Mailing Address - Fax:310-888-7754
Practice Address - Street 1:415 N CRESCENT DR STE 220
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6810
Practice Address - Country:US
Practice Address - Phone:310-888-7737
Practice Address - Fax:310-888-7754
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066667207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16891Medicare ID - Type Unspecified