Provider Demographics
NPI:1629889597
Name:POURKASHEF, PAYAM (LAC, DACM)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:POURKASHEF
Suffix:
Gender:M
Credentials:LAC, DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DOVER DR STE 226
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5500
Mailing Address - Country:US
Mailing Address - Phone:949-735-1410
Mailing Address - Fax:
Practice Address - Street 1:901 DOVER DR STE 226
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5500
Practice Address - Country:US
Practice Address - Phone:949-735-1410
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-18
Last Update Date:2025-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8316171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty