Provider Demographics
NPI:1255566840
Name:PAYAM JARRAHNEJAD MD A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:PAYAM JARRAHNEJAD MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:
Authorized Official - Last Name:JARRAHNEJAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-993-3800
Mailing Address - Street 1:465 N ROXBURY DR STE 1017
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4213
Mailing Address - Country:US
Mailing Address - Phone:310-993-3800
Mailing Address - Fax:310-388-1617
Practice Address - Street 1:465 N ROXBURY DR STE 1017
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4213
Practice Address - Country:US
Practice Address - Phone:310-993-3800
Practice Address - Fax:310-388-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-26
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA890982086S0105X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA89098OtherLICENCE