Provider Demographics
NPI:1205807146
Name:VEISEH, AFSHIN S (MD)
Entity type:Individual
Prefix:
First Name:AFSHIN
Middle Name:S
Last Name:VEISEH
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 1:100 UCLA MEDICAL PLAZA
Mailing Address - Street 2:#720
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-7001
Mailing Address - Country:US
Mailing Address - Phone:310-794-7940
Mailing Address - Fax:310-209-1577
Practice Address - Street 1:100 UCLA MEDICAL PLAZA
Practice Address - Street 2:#720
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-7001
Practice Address - Country:US
Practice Address - Phone:310-794-7940
Practice Address - Fax:310-209-1577
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-09-06
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
CAG74878208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74878OtherUNITED HCARE
CAOOG748782Medicaid
CAG74878BOtherB X OF CALIF
CAOOG748782Medicaid