Provider Demographics
NPI:1194732578
Name:REZAPOUR, JOHN G (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:REZAPOUR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:16661 VENTURA BLVD STE 211
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1938
Mailing Address - Country:US
Mailing Address - Phone:818-205-1200
Mailing Address - Fax:818-205-1254
Practice Address - Street 1:16661 VENTURA BLVD STE 211
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1938
Practice Address - Country:US
Practice Address - Phone:818-205-1200
Practice Address - Fax:818-205-1254
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA77006207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A770061Medicaid
CA00A770061Medicaid
H77725Medicare UPIN