Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 20A8510 | CA |
NPI | 1346341575 |
---|---|
Provider Name | Paymon Banafshe |
First Address | Los Angeles, CA 90045-3801 |
Second Address | Los Angeles, CA 90045-3801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 16/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I48789 | (02) | CA |