Healthcare Provider Details

I. General information

NPI: 1528419710
Provider Name (Legal Business Name): SAEID KARANDISH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 04/05/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD STE 311
ENCINO CA
91436-1955
US

IV. Provider business mailing address

3733 OAKFIELD DR
SHERMAN OAKS CA
91423-4430
US

V. Phone/Fax

Practice location:
  • Phone: 800-555-4110
  • Fax:
Mailing address:
  • Phone: 818-271-1966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number302638
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA171897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: