Provider Demographics
NPI:1972523728
Name:JAZAYERI, AZAM (MD)
Entity Type:Individual
Prefix:MRS
First Name:AZAM
Middle Name:
Last Name:JAZAYERI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3831 HUGHES AVE
Mailing Address - Street 2:STE 502
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232
Mailing Address - Country:US
Mailing Address - Phone:310-558-8895
Mailing Address - Fax:310-204-7033
Practice Address - Street 1:3831 HUGHES AVE
Practice Address - Street 2:STE 502
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232
Practice Address - Country:US
Practice Address - Phone:310-558-8895
Practice Address - Fax:310-204-7033
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA048488208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A484881Medicaid