Provider Demographics
NPI:1396760120
Name:ASGARI, AZIZEH (MD)
Entity type:Individual
Prefix:DR
First Name:AZIZEH
Middle Name:
Last Name:ASGARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16040 W SUNSET BLVD
Mailing Address - Street 2:APT 205
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3462
Mailing Address - Country:US
Mailing Address - Phone:818-613-6046
Mailing Address - Fax:310-310-3146
Practice Address - Street 1:16040 W SUNSET BLVD
Practice Address - Street 2:APT 205
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3462
Practice Address - Country:US
Practice Address - Phone:818-613-6046
Practice Address - Fax:310-310-3146
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48989207VG0400X
OK27528207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200271700AMedicaid
OKOK404932Medicare PIN