Healthcare Provider Details

I. General information

NPI: 1366731762
Provider Name (Legal Business Name): RAEESY MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16311 VENTURA BLVD STE 955
ENCINO CA
91436-4339
US

IV. Provider business mailing address

16311 VENTURA BLVD STE 955
ENCINO CA
91436-4339
US

V. Phone/Fax

Practice location:
  • Phone: 818-701-0017
  • Fax: 818-701-0073
Mailing address:
  • Phone: 818-701-0017
  • Fax: 818-701-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA97308
License Number StateCA

VIII. Authorized Official

Name: AMIR HOMAYON RAEESY
Title or Position: OWNER
Credential: MD
Phone: 818-701-0073