Provider Demographics
NPI:1891802013
Name:LALEZARI, BAHMAN (MD)
Entity Type:Individual
Prefix:
First Name:BAHMAN
Middle Name:
Last Name:LALEZARI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BAHMAN
Other - Middle Name:
Other - Last Name:LALEZARIKHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4944 WEST PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4228
Mailing Address - Country:US
Mailing Address - Phone:323-939-5346
Mailing Address - Fax:323-939-5217
Practice Address - Street 1:4944 WEST PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4228
Practice Address - Country:US
Practice Address - Phone:323-939-5346
Practice Address - Fax:323-939-5217
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51462207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514622Medicaid
CAA51462AMedicare ID - Type Unspecified
CA00A514622Medicaid