Provider Demographics
NPI:1821210329
Name:AFSHIN AKHAVAN D.O., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:AFSHIN AKHAVAN D.O., A PROFESSIONAL CORPORATION
Other - Org Name:MEDICAL CENTRAL FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AFSHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-730-1663
Mailing Address - Street 1:530 E WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3723
Mailing Address - Country:US
Mailing Address - Phone:213-747-2626
Mailing Address - Fax:213-749-7500
Practice Address - Street 1:530 E WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3723
Practice Address - Country:US
Practice Address - Phone:213-747-2626
Practice Address - Fax:213-749-7500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7610208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18131Medicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER#