# PEYMAN BANOONI MEDICAL GROUP, INC

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

## Provider details

- **NPI number:** 1811497035
- **Authorized official:** MR. PEYMAN BANOONI M.D. (MEDICAL DIRECTOR)
- **Authorized official phone:** (310) 625-4643

## Contact information

- **Practice address:** 1030 GARDENA BLVD, GARDENA, CA 90247-4956
- **Practice address phone:** (213) 413-2222
- **Mailing address:** 269 S BEVERLY DR, SUITE 468, BEVERLY HILLS, CA 90212-3851

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | A75080 | CA | Yes |

## Other

- **Enumeration date:** 02/14/2018
- **Last updated:** 02/14/2018