Individual
BOBAK JASON AKHAVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4650 LINCOLN BLVD, MARINA DEL REY, CA 90292-6306
(310) 823-8911
(310) 577-5694
Mailing address
4140 W 190TH ST, TORRANCE, CA 90504-5513
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
R5495
TX
207RP1001X
Pulmonary Disease Physician
Primary
A163091
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2015
Last updated
08/19/2022
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