Provider Demographics
NPI:1710001722
Name:YERMIAN, PAYAM (DC)
Entity Type:Individual
Prefix:DR
First Name:PAYAM
Middle Name:
Last Name:YERMIAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2637
Mailing Address - Country:US
Mailing Address - Phone:310-828-8808
Mailing Address - Fax:310-828-8919
Practice Address - Street 1:3200 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2637
Practice Address - Country:US
Practice Address - Phone:310-828-8808
Practice Address - Fax:310-828-8919
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC-28201111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC0282010OtherBLUE SHIELD OF CA
CADC0282010OtherBLUE SHIELD OF CA
CADC28201Medicare ID - Type UnspecifiedPROVIDER ID # MEDICARE