Basic Information
| Provider Information | |||||||||
| NPI: | 1760677892 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAFEH | ||||||||
| FirstName: | BANAFSHEH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 701 E 28TH ST | ||||||||
| Address2: | SUITE 319 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624263656 | ||||||||
| FaxNumber: | 5624249990 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 E 28TH ST | ||||||||
| Address2: | SUITE 319 | ||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908062759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624263656 | ||||||||
| FaxNumber: | 5624249990 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/11/2007 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084V0102X | A90526 | CA | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology | 2084V0102X | 036122614 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
ID Information
| ID | Type | State | Issuer | Description | W6126 | 01 | CA | MEDICARE GROUP PTAN | OTHER |