Provider Demographics
NPI:1053725317
Name:PARVIZ AKHAVAN DO A MEDICAL CORP
Entity type:Organization
Organization Name:PARVIZ AKHAVAN DO A MEDICAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRVIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:323-750-2325
Mailing Address - Street 1:723 E MANCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90001-3632
Mailing Address - Country:US
Mailing Address - Phone:323-750-2325
Mailing Address - Fax:
Practice Address - Street 1:723 E MANCHESTER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-3632
Practice Address - Country:US
Practice Address - Phone:323-750-2325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PARVIZ AKHAVAN DO A MEDICAL CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7522261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADO769AOtherPTAN(S)