Provider Demographics
NPI:1154376580
Name:YAZDANI, NASIMEH (MD)
Entity type:Individual
Prefix:
First Name:NASIMEH
Middle Name:
Last Name:YAZDANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2319 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5801
Mailing Address - Country:US
Mailing Address - Phone:310-393-5000
Mailing Address - Fax:310-393-5007
Practice Address - Street 1:2319 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5801
Practice Address - Country:US
Practice Address - Phone:310-393-5000
Practice Address - Fax:310-393-5007
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90937207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP287ZMedicare PIN