Active NPI
Maryam Mofarrah Younessi, PA-C
- Physician Assistant
- Los Angeles, CA
National Provider Identifier
1841585932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 21569
- Practice address
- 11645 Wilshire Blvd Ste 800
Los Angeles, CA 90025-6811 - Phone
- (310) 443-5273
- NPI assigned
- Jun 16, 2011
- Last updated
- Jun 5, 2012
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 21569 | CA | Primary |
Addresses
Primary practice location
11645 Wilshire Blvd Ste 800
Los Angeles, CA 90025-6811
Mailing address
14521 Benefit St
Unit 105
Sherman Oaks, CA 91403-3702
Phone (818) 632-9473
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)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21569 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308182400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1338854400000",
"number": "1841585932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14521 BENEFIT ST",
"address_2": "UNIT 105",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914033702",
"telephone_number": "818-632-9473"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11645 WILSHIRE BLVD STE 800",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900256811",
"telephone_number": "310-443-5273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YOUNESSI",
"first_name": "MARYAM",
"middle_name": "MOFARRAH",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-06-16",
"last_updated": "2012-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "21569",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
- Fariba S. Younai, D.D.S.
- Margaret Younan
- Laura Younes
- Fargol Limor Younesi, PHARMD
- Elena Younessi
- Shohreh Younessian Pedouim, ACUPUNCTURIST
- Young Bae Kim D.D.S Inc. (Barun Dental Group)
- Young Choi Dental Group
- Young Choi Medical Corporation
- Young H. Kim and Doil Kim DDS Inc (Doil Kim DDS MMSc Orthodontics)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.