Provider Demographics
NPI:1578225140
Name:EVOLVE CONCIERGE
Entity type:Organization
Organization Name:EVOLVE CONCIERGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAHRYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:YADEGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-363-6910
Mailing Address - Street 1:18399 VENTURA BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6403
Mailing Address - Country:US
Mailing Address - Phone:818-609-7536
Mailing Address - Fax:
Practice Address - Street 1:18356 CLARK ST STE 101
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3502
Practice Address - Country:US
Practice Address - Phone:818-978-7888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-11
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC4788092OtherCA SECRETARY OF STATE