Provider Demographics
NPI:1689978850
Name:PEYMAN BANOONI MEDICAL GROUP INC
Entity Type:Organization
Organization Name:PEYMAN BANOONI MEDICAL GROUP INC
Other - Org Name:7TH STREET MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEYMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANOONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-625-4643
Mailing Address - Street 1:1919 W 7TH ST
Mailing Address - Street 2:UNIT 2A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4103
Mailing Address - Country:US
Mailing Address - Phone:310-625-4643
Mailing Address - Fax:310-652-3489
Practice Address - Street 1:1919 W 7TH ST
Practice Address - Street 2:UNIT 2A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4103
Practice Address - Country:US
Practice Address - Phone:310-625-4643
Practice Address - Fax:310-652-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty