Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20A7610 | CA |
N | 207V00000X | Obstetrician & Gynecologist | 20A7610 | CA |
N | 208D00000X | General Practice Physician | 20A7610 | CA |
NPI | 1003952797 |
---|---|
Provider Name | Dr. Afshin Akhavan |
First Address | Los Angeles, CA 90015-3723 |
Second Address | Los Angeles, CA 90015-3723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 15/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00AX76100 | (05) | CA |
H75529 | (02) |