Active NPI
Maryam Mokhtarzadeh, M.D.
- Ophthalmology Physician
- Los Angeles, CA
National Provider Identifier
1164629150
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- A104706
- Practice address
- 2201 S Beverly Glen Blvd
Apt.#304
Los Angeles, CA 90064-2415 - Phone
- (248) 219-5039
- NPI assigned
- Jul 2, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | A104706 | CA | Primary |
Addresses
Primary practice location
2201 S Beverly Glen Blvd
Apt.#304
Los Angeles, CA 90064-2415
Mailing address
2201 S Beverly Glen Blvd
Apt.#304
Los Angeles, CA 90064-2415
Phone (248) 219-5039
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A104706 | CA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183334400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254700800000",
"number": "1164629150",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2201 S BEVERLY GLEN BLVD",
"address_2": "APT.#304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900642415",
"telephone_number": "248-219-5039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2201 S BEVERLY GLEN BLVD",
"address_2": "APT.#304",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900642415",
"telephone_number": "248-219-5039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOKHTARZADEH",
"first_name": "MARYAM",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-07-02",
"last_updated": "2009-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "A104706",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.