Provider Demographics
NPI:1699118752
Name:KAMAL BIJANPOUR INC
Entity type:Organization
Organization Name:KAMAL BIJANPOUR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:BIJANPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-801-5473
Mailing Address - Street 1:3000 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3158
Mailing Address - Country:US
Mailing Address - Phone:310-559-5916
Mailing Address - Fax:310-559-5466
Practice Address - Street 1:3605 LONG BEACH BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-6018
Practice Address - Country:US
Practice Address - Phone:310-559-5916
Practice Address - Fax:310-559-5466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-09
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2084P0800X, 2084P0802X
CAA109162282NC0060X, 283Q00000X, 305R00000X, 310400000X, 3104A0625X, 3104A0630X, 314000000X, 315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes283Q00000XHospitalsPsychiatric HospitalGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No282NC0060XHospitalsGeneral Acute Care HospitalCritical AccessGroup - Multi-Specialty
No305R00000XManaged Care OrganizationsPreferred Provider Organization
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A1091620Medicaid