| Pouya Bahrami DO, Inc | |
|
1245 Wilshire Blvd Suite 611 Los Angeles CA 90017-4810 | |
| (213) 481-2200 | |
| Not Available |
| Full Name | Pouya Bahrami DO, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1245 Wilshire Blvd, Los Angeles, California |
| Authorized Official Name and Position | Pouya Bahrami (PRESIDENT) |
| Authorized Official Contact | 2134812200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pouya Bahrami DO, Inc 1414 S Grand Ave Suite 100 Los Angeles CA 90015-3067 Ph: (213) 481-2200 | Pouya Bahrami DO, Inc 1245 Wilshire Blvd Suite 611 Los Angeles CA 90017-4810 Ph: (213) 481-2200 |
| NPI Number | 1053506402 |
|---|---|
| Provider Enumeration Date | 09/10/2007 |
| Last Update Date | 08/05/2016 |
| Medicare PECOS PAC ID | 9133206311 |
|---|---|
| Medicare Enrollment ID | O20080411000638 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053506402 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | () | Primary |
| Provider Name | Pouya Bahrami |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871526301 PECOS PAC ID: 0749177368 Enrollment ID: I20040228000568 |
| Provider Name | Angelina D Bucu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730522764 PECOS PAC ID: 1153336524 Enrollment ID: I20130610000129 |
| Provider Name | Janee N Malan |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1750845483 PECOS PAC ID: 2567795289 Enrollment ID: I20190612002695 |
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