Provider Demographics
NPI:1689982365
Name:ARASH AFARI PROFESSIONAL MED CORP
Entity Type:Organization
Organization Name:ARASH AFARI PROFESSIONAL MED CORP
Other - Org Name:ARCHER RADIOLOGY CENTURY CITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:AFARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-626-8315
Mailing Address - Street 1:2355 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 259
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2109
Mailing Address - Country:US
Mailing Address - Phone:800-626-8315
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1410
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:800-626-8315
Practice Address - Fax:800-650-0615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA978662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA9271152OtherAETNA
CA00A978660Medicaid
CAZZZ53210YOtherBLUESHIELD/TRICARE
CA1982861852OtherCALIFORNIA'S VALUED TRUST
CAZZZ53210YOtherUNITED HEALTHCARE
CA1982861852OtherCALIFORNIA'S VALUED TRUST
CAZZZ53210YOtherUNITED HEALTHCARE
CA1982861852Medicare UPIN