Provider Demographics
NPI:1306920194
Name:NAFICY, MOHAMAD DJAVAD (MD)
Entity type:Individual
Prefix:DR
First Name:MOHAMAD
Middle Name:DJAVAD
Last Name:NAFICY
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:PO BOX 5360
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-5360
Mailing Address - Country:US
Mailing Address - Phone:310-909-3916
Mailing Address - Fax:
Practice Address - Street 1:9107 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5531
Practice Address - Country:US
Practice Address - Phone:310-909-3916
Practice Address - Fax:310-246-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51746174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-2850704OtherFED TAX ID
26-2850704OtherFED TAX ID