Provider Demographics
NPI:1447288147
Name:ABRISHAMI, PAYAM (MD)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:
Last Name:ABRISHAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MONTEGO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-1617
Mailing Address - Country:US
Mailing Address - Phone:818-338-7097
Mailing Address - Fax:818-338-7099
Practice Address - Street 1:29525 CANWOOD ST STE 109
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4230
Practice Address - Country:US
Practice Address - Phone:818-338-7097
Practice Address - Fax:818-338-7099
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86627207ND0101X, 207ZD0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A866270OtherMEDI CAL
CAP00729841OtherRAILROAD MEDICARE
CA00A866270OtherBLUE SHIELD
CA00A866275Medicare UPIN
CAWA86627BMedicare ID - Type Unspecified
CABK504XMedicare PIN
CAWA86627HMedicare PIN
CAWA86627IMedicare PIN
AZZ131634Medicare PIN
CA00A8666274Medicare PIN
CA00A866270OtherMEDI CAL
CA00A866277Medicare PIN
CABK504YMedicare PIN
CAWA86627FMedicare PIN
PA147245YPTMedicare PIN
CAWA86627AMedicare PIN
CA00A866272Medicare PIN
CAI16519Medicare UPIN
CAWA86627GMedicare PIN
CAWA86627JMedicare PIN
CAWA86627LMedicare PIN
AZZ131635Medicare PIN
CA00A866276Medicare PIN
CA00A866274Medicare PIN
CA00A866270Medicare PIN
CAP00729841OtherRAILROAD MEDICARE
ID1196069Medicare PIN
WVAB4265941Medicare PIN
CABK504VMedicare PIN
NVBN361ZMedicare PIN
CAWA86627NMedicare PIN
CA00A866273Medicare PIN
CA00A866270OtherBLUE SHIELD
PA147245ZEGSMedicare PIN
CAWA86627QMedicare PIN
CA00A866271Medicare PIN
CABK504ZMedicare PIN