Provider Demographics
NPI:1194801167
Name:BEHMANESH, BEHZAD (MD)
Entity type:Individual
Prefix:MR
First Name:BEHZAD
Middle Name:
Last Name:BEHMANESH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2701 WEST ALAMEDA AVE
Mailing Address - Street 2:604
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4411
Mailing Address - Country:US
Mailing Address - Phone:818-845-5000
Mailing Address - Fax:818-845-5004
Practice Address - Street 1:2701 WEST ALAMEDA AVE
Practice Address - Street 2:604
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4411
Practice Address - Country:US
Practice Address - Phone:818-845-5000
Practice Address - Fax:818-845-5004
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA052472208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA052472Medicaid