Organization
PEYMAN BANOONI MEDICAL GROUP INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PEYMAN BANOONI M.D. (MEDICAL DIRECTOR)
(323) 588-8855
Entity
Organization
Contact information
Practice address
6120 SEVILLE AVE, UNIT B, HUNTINGTON PARK, CA 90255-2911
(323) 588-8855
(323) 587-5474
Mailing address
269 S BEVERLY DR, 468, BEVERLY HILLS, CA 90212-3851
(323) 588-8855
(323) 587-5474
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A75080
CA
208D00000X
General Practice Physician
A75080
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A750801
—
CA
05
—
1811002777
—
CA
Enumeration date
06/11/2014
Last updated
06/13/2014
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