# PEYMAN BANOONI MEDICAL GROUP INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093128688
- **Authorized official:** PEYMAN BANOONI M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (323) 588-8855

## Contact information

- **Practice address:** 6120 SEVILLE AVE, UNIT B, HUNTINGTON PARK, CA 90255-2911
- **Practice address phone:** (323) 588-8855
- **Practice address fax:** (323) 587-5474
- **Mailing address:** 269 S BEVERLY DR, 468, BEVERLY HILLS, CA 90212-3851
- **Mailing address phone:** (323) 588-8855
- **Mailing address fax:** (323) 587-5474

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | A75080 | CA | Yes |
| 208D00000X | General Practice Physician | A75080 | CA | — |

## Other

- **Enumeration date:** 06/11/2014
- **Last updated:** 06/13/2014