Provider Demographics
NPI:1871612630
Name:PAYAM ROBERT YASHAR, M.D., INC
Entity type:Organization
Organization Name:PAYAM ROBERT YASHAR, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAYAM
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:YASHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-556-2020
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0516
Mailing Address - Country:US
Mailing Address - Phone:310-556-2020
Mailing Address - Fax:310-556-2025
Practice Address - Street 1:8635 W 3RD ST STE 265W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6154
Practice Address - Country:US
Practice Address - Phone:310-556-2020
Practice Address - Fax:310-556-2025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66101207RC0000X
207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661010Medicaid
CA00A661010Medicaid
CAI19746Medicare UPIN