Provider Demographics
NPI:1780651844
Name:YASHARI, MANOOCHEHR (MD)
Entity type:Individual
Prefix:DR
First Name:MANOOCHEHR
Middle Name:
Last Name:YASHARI
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 1:1304 15TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1810
Mailing Address - Country:US
Mailing Address - Phone:310-393-4655
Mailing Address - Fax:310-394-8352
Practice Address - Street 1:1304 15TH ST STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1810
Practice Address - Country:US
Practice Address - Phone:310-393-4655
Practice Address - Fax:310-394-8352
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39333207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C39333Medicaid
CAC39333Medicare PIN