Provider Demographics
NPI:1942465232
Name:VAFAIE, JANET (MD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:VAFAIE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10647 ASHTON AVE
Mailing Address - Street 2:UNIT 302
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-5288
Mailing Address - Country:US
Mailing Address - Phone:310-456-5459
Mailing Address - Fax:310-456-5469
Practice Address - Street 1:10921 WILSHIRE BLVD
Practice Address - Street 2:STE 800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4003
Practice Address - Country:US
Practice Address - Phone:310-456-5459
Practice Address - Fax:310-456-5469
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA90755207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB213280Medicare PIN