Basic Information
| Provider Information | |||||||||
| NPI: | 1154583938 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAYAM | ||||||||
| FirstName: | AHOORA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 9602 | ||||||||
| Address2: | |||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913469602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188375559 | ||||||||
| FaxNumber: | 8187924793 | ||||||||
| Practice Location | |||||||||
| Address1: | 191 S BUENA VISTA ST | ||||||||
| Address2: | STE 100 | ||||||||
| City: | BURBANK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 915054562 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188697600 | ||||||||
| FaxNumber: | 8184333692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 06/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 5560 | HI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | C171926 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 17565 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 17565 | 01 | NV | STATE LICENSE | OTHER | 1154583983 | 05 | NV | MEDICAID |