Basic Information
Provider Information
NPI: 1093049942
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: AKHAVAN
FirstName: RAMIN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4324 RIVERWALK PARKWAY, SUITE 230
Address2: PACIFIC PULMONARY MEDICAL GROUP
City: RIVERSIDE
State: CA
PostalCode: 92505
CountryCode: US
TelephoneNumber: 9517813672
FaxNumber: 9517813605
Practice Location
Address1: 4324 RIVERWALK PARKWAY, SUITE 230
Address2: PACIFIC PULMONARY MEDICAL GROUP
City: RIVERSIDE
State: CA
PostalCode: 92505
CountryCode: US
TelephoneNumber: 9517813672
FaxNumber: 9517813605
Other Information
ProviderEnumerationDate: 09/24/2009
LastUpdateDate: 03/25/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XA100615CAN Allopathic & Osteopathic PhysiciansAnesthesiology 
207RC0200XA100615CAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

No ID Information.


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