| Dornika Medical, Inc. | |
|
2121 S San Pedro St Unit E Los Angeles CA 90011-1160 | |
| (213) 747-0300 | |
| (213) 746-0044 |
| Full Name | Dornika Medical, Inc. |
|---|---|
| Speciality | Family Medicine |
| Location | 2121 S San Pedro St, Los Angeles, California |
| Authorized Official Name and Position | Bijan Motamedi (PART OWNER) |
| Authorized Official Contact | 2137470300 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dornika Medical, Inc. 125 Oasis Irvine CA 92620-7315 Ph: (213) 747-0300 | Dornika Medical, Inc. 2121 S San Pedro St Unit E Los Angeles CA 90011-1160 Ph: (213) 747-0300 |
| NPI Number | 1417365545 |
|---|---|
| Provider Enumeration Date | 08/01/2014 |
| Last Update Date | 08/01/2014 |
| Medicare PECOS PAC ID | 0446573471 |
|---|---|
| Medicare Enrollment ID | O20141226000495 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417365545 | NPI | - | NPPES |
| A76326 | Other | CA | PROVIDER LISCENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A76326 (California) | Primary |
| Provider Name | Bijan Motamedi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801834171 PECOS PAC ID: 4284625104 Enrollment ID: I20060105000600 |
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