Provider Demographics
NPI:1992840680
Name:JAVID TAVARI, D.O., INC.
Entity Type:Organization
Organization Name:JAVID TAVARI, D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAVARI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:310-696-0100
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 745
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-696-0100
Mailing Address - Fax:310-696-0700
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 745
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-696-0100
Practice Address - Fax:310-696-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QS0010X
CA20A6273207R00000X, 207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A62731OtherBLUE SHIELD
CA020A62731OtherBLUE CROSS
CA020A62730OtherBLUE CROSS
CAFNP2021OtherOSTEOPATHIC MEDICAL BOARD OF CALIFORNIA
CA020A62730OtherBLUE CROSS
CA20A6273AMedicare ID - Type UnspecifiedMEDICARE