Healthcare Provider Details

I. General information

NPI: 1689954513
Provider Name (Legal Business Name): SINA EMAMI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SINA EMAMIMOGHADAM TEHRANI MD

II. Dates (important events)

Enumeration Date: 08/23/2011
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15503 VENTURA BLVD, STE 170
ENCINO CA
91436
US

IV. Provider business mailing address

15503 VENTURA BLVD, STE 170
ENCINO CA
91436
US

V. Phone/Fax

Practice location:
  • Phone: 818-783-0004
  • Fax: 818-783-0007
Mailing address:
  • Phone: 818-783-0004
  • Fax: 818-783-0007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA142845
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA142845
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: