Basic Information
| Provider Information | |||||||||
| NPI: | 1114172897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAVABI | ||||||||
| FirstName: | KASRA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5767 W CENTURY BLVD STE 400 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900455631 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 200 MEDICAL PLAZA | ||||||||
| Address2: | #530 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900240001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107941276 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2008 | ||||||||
| LastUpdateDate: | 06/04/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD2012-0589 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | A116768 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RE0101X | MD2012-0589 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | 207RE0101X | A116768 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | MD2012-0589 | 01 | NM | NEW MEXICO MEDICAL BOARD | OTHER | A116768 | 01 | CA | MEDICAL BOARD OF CALIFORNIA | OTHER |