NPIMap

Organization Active NPI

Peyman Banooni Medical Group Inc.

  • Obstetrics & Gynecology Physician
  • Huntington Park, CA
National Provider Identifier
1093128688
Registry record updated Jun 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A75080 Issued in CA
Legal business name
PEYMAN BANOONI MEDICAL GROUP INC.
Practice address
6120 Seville Ave
Unit B
Huntington Park, CA 90255-2911
Phone
(323) 588-8855
Fax
(323) 587-5474
NPI assigned
Jun 11, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Peyman Banooni, M.D.NPI 1811002777
Title
Medical Director
Phone
(323) 588-8855

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X A75080 CA Primary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X A75080 CA

Addresses

Primary practice location

6120 Seville Ave
Unit B
Huntington Park, CA 90255-2911

Mailing address

269 S Beverly Dr
468
Beverly Hills, CA 90212-3851
Phone (323) 588-8855

Other identifiers 2

IdentifierTypeStateIssuer
00A750801MedicaidCA
1811002777MedicaidCA

National Provider Directory

National Provider Directory
Tax ID family
Peyman Banooni Medical Group Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

6120 Seville Ave
Unit B
Huntington Park, CA 90255
Phone (323) 588-8855

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402617600000",
    "number": "1093128688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "269 S BEVERLY DR",
            "address_2": "468",
            "city": "BEVERLY HILLS",
            "state": "CA",
            "postal_code": "902123851",
            "telephone_number": "323-588-8855",
            "fax_number": "323-587-5474"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6120 SEVILLE AVE",
            "address_2": "UNIT B",
            "city": "HUNTINGTON PARK",
            "state": "CA",
            "postal_code": "902552911",
            "telephone_number": "323-588-8855",
            "fax_number": "323-587-5474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEYMAN BANOONI MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-13",
        "status": "A",
        "authorized_official_last_name": "BANOONI",
        "authorized_official_first_name": "PEYMAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "323-588-8855",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A75080",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "A75080",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A750801",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811002777",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntington Park, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.