Basic Information
| Provider Information | |||||||||
| NPI: | 1073520920 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EMAD | ||||||||
| FirstName: | BEHZAD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11693 SAN VICENTE BLVD | ||||||||
| Address2: | PMB 222 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239329880 | ||||||||
| FaxNumber: | 3239329829 | ||||||||
| Practice Location | |||||||||
| Address1: | 5757 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 660 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900365810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239329880 | ||||||||
| FaxNumber: | 3239329829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 03/07/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | A055727 | CA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00A557270 | 05 | CA | MEDICAID |