Provider Demographics
NPI:1184613382
Name:RIYAZ, AZAM SAYEED (MD)
Entity type:Individual
Prefix:
First Name:AZAM
Middle Name:SAYEED
Last Name:RIYAZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23451 MADISON ST STE 290
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4737
Mailing Address - Country:US
Mailing Address - Phone:310-375-1246
Mailing Address - Fax:310-375-0590
Practice Address - Street 1:23451 MADISON ST STE 290
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4737
Practice Address - Country:US
Practice Address - Phone:310-375-1246
Practice Address - Fax:310-375-0590
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61966207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1969187OtherCAQH
I7732521OtherAETNA