Provider Demographics
NPI:1962718825
Name:MOFTAKHAR PARHAM, MD
Entity type:Organization
Organization Name:MOFTAKHAR PARHAM, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOFTAKHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PARHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-427-9869
Mailing Address - Street 1:3240 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1502
Mailing Address - Country:US
Mailing Address - Phone:213-437-9869
Mailing Address - Fax:213-365-4080
Practice Address - Street 1:3240 WILSHIRE BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1502
Practice Address - Country:US
Practice Address - Phone:213-427-9869
Practice Address - Fax:213-365-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112460208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty