Healthcare Provider Details

I. General information

NPI: 1073661807
Provider Name (Legal Business Name): JAMSHEED AKHAVAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 10/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22030 SHERMAN WAY SUITE # 101
CANOGA PARK CA
91303-1844
US

IV. Provider business mailing address

22030 SHERMAN WAY SUITE # 101
CANOGA PARK CA
91303-1844
US

V. Phone/Fax

Practice location:
  • Phone: 818-312-9101
  • Fax: 818-312-9100
Mailing address:
  • Phone: 818-312-9101
  • Fax: 818-312-9100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA47734
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: