Provider Demographics
NPI:1447699384
Name:TAHERPOUR, PARVIZ (MD)
Entity type:Individual
Prefix:
First Name:PARVIZ
Middle Name:
Last Name:TAHERPOUR
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 1:124 N VIGNES ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-4030
Mailing Address - Country:US
Mailing Address - Phone:213-626-5679
Mailing Address - Fax:213-680-0185
Practice Address - Street 1:124 N VIGNES ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4030
Practice Address - Country:US
Practice Address - Phone:213-626-5679
Practice Address - Fax:213-680-0185
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28671208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710616Medicaid