Provider Demographics
NPI:1801959069
Name:MAHAISAVARIYA, PAIBOON (MD)
Entity type:Individual
Prefix:DR
First Name:PAIBOON
Middle Name:
Last Name:MAHAISAVARIYA
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 1:8317 DAVIS STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-5021
Mailing Address - Country:US
Mailing Address - Phone:562-869-1511
Mailing Address - Fax:562-869-0771
Practice Address - Street 1:8317 DAVIS STREET
Practice Address - Street 2:SUITE A
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-5021
Practice Address - Country:US
Practice Address - Phone:562-869-1511
Practice Address - Fax:562-869-0771
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66961207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G669610Medicaid
CA060068099OtherMEDICARE RAILROAD
CAWG66961EMedicare PIN
CAWG66961DMedicare PIN
CA060068099OtherMEDICARE RAILROAD