Provider Demographics
NPI:1447813332
Name:BEHNAM EBRAHIMI MD INC
Entity type:Organization
Organization Name:BEHNAM EBRAHIMI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEHNAM
Authorized Official - Middle Name:
Authorized Official - Last Name:EBRAHIMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-865-9500
Mailing Address - Street 1:1910 ROYALTY DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3021
Mailing Address - Country:US
Mailing Address - Phone:602-441-9520
Mailing Address - Fax:602-441-9524
Practice Address - Street 1:1910 ROYALTY DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3021
Practice Address - Country:US
Practice Address - Phone:909-630-7342
Practice Address - Fax:909-630-7299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty