Provider Demographics
NPI:1144279514
Name:YASHAR, PAYAM ROBERT (MD)
Entity type:Individual
Prefix:
First Name:PAYAM
Middle Name:ROBERT
Last Name:YASHAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:PAYAM
Other - Middle Name:ROBERT
Other - Last Name:YASHAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD INC
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213
Mailing Address - Country:US
Mailing Address - Phone:310-556-2020
Mailing Address - Fax:310-788-8477
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:SUITE 1050W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-556-2020
Practice Address - Fax:310-788-8477
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66101207RC0000X, 207RC0001X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A661010Medicaid
CAW18096Medicare ID - Type Unspecified
CA00A661010Medicaid