Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A85379 | CA |
Y | 208600000X | Surgeon | A85379 | CA |
NPI | 1003000639 |
---|---|
Provider Name | Dr. Peyman Benharash |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 18/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A853790 | (05) | CA |