Provider Demographics
NPI:1841325099
Name:PEIMAN BERDJIS MD INC
Entity type:Organization
Organization Name:PEIMAN BERDJIS MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEIMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERDJIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-277-2999
Mailing Address - Street 1:PO BOX 5349
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-5349
Mailing Address - Country:US
Mailing Address - Phone:323-525-1999
Mailing Address - Fax:323-525-1991
Practice Address - Street 1:6222 WILSHIRE BLVD STE 303
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5193
Practice Address - Country:US
Practice Address - Phone:323-525-1999
Practice Address - Fax:323-525-1991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA067173207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A671730Medicaid
CAH42803Medicare UPIN
CAW18719Medicare ID - Type Unspecified