Healthcare Provider Details

I. General information

NPI: 1437112604
Provider Name (Legal Business Name): SAEID SAFAEE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SAEID SAFAEE-SEMIROMI MD

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 W GLENOAKS BLVD
GLENDALE CA
91201-1912
US

IV. Provider business mailing address

1511 W GLENOAKS BLVD
GLENDALE CA
91201-1912
US

V. Phone/Fax

Practice location:
  • Phone: 818-637-2200
  • Fax: 818-637-2250
Mailing address:
  • Phone: 818-637-2200
  • Fax: 818-637-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberC-53279
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC-53279
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberC-53279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: