Provider Demographics
NPI:1922429406
Name:POUYA LAVIAN MD INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:POUYA LAVIAN MD INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:POUYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-394-0884
Mailing Address - Street 1:16661 VENTURA BLVD STE 820
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4801
Mailing Address - Country:US
Mailing Address - Phone:818-394-0884
Mailing Address - Fax:818-217-8318
Practice Address - Street 1:16661 VENTURA BLVD STE 820
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4801
Practice Address - Country:US
Practice Address - Phone:818-394-0884
Practice Address - Fax:818-217-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-30
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109429204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA109429OtherLICENSE