Provider Demographics
NPI:1710231279
Name:CYRUS R LAVIAN, M.D., INC
Entity Type:Organization
Organization Name:CYRUS R LAVIAN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYRUS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-510-3126
Mailing Address - Street 1:16020 VALLEY WOOD RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-4737
Mailing Address - Country:US
Mailing Address - Phone:818-510-3126
Mailing Address - Fax:
Practice Address - Street 1:16020 VALLEY WOOD RD
Practice Address - Street 2:SUITE 110
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-4737
Practice Address - Country:US
Practice Address - Phone:818-510-3126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty