Provider Demographics
NPI:1134454226
Name:ENAYATI, JOSEPH PEJMAN (DO)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PEJMAN
Last Name:ENAYATI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 S ROBERTSON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1630
Mailing Address - Country:US
Mailing Address - Phone:310-651-6937
Mailing Address - Fax:310-388-0185
Practice Address - Street 1:822 S ROBERTSON BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1630
Practice Address - Country:US
Practice Address - Phone:310-651-6937
Practice Address - Fax:310-388-0185
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13199208VP0014X, 207L00000X
NY269503208VP0014X
CA13199208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB228097Medicare PIN