Healthcare Provider Details

I. General information

NPI: 1679469589
Provider Name (Legal Business Name): SIERRA MED-LEGAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2025
Last Update Date: 06/16/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16530 VENTURA BLVD STE D # 526
ENCINO CA
91436-4554
US

IV. Provider business mailing address

16530 VENTURA BLVD STE D # 526
ENCINO CA
91436-4554
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-2222
  • Fax:
Mailing address:
  • Phone: 818-905-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SHREY KANJIYA
Title or Position: PRESIDENT
Credential: MD
Phone: 562-905-6536