Healthcare Provider Details

I. General information

NPI: 1093027740
Provider Name (Legal Business Name): SEPAND SALEHIAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2010
Last Update Date: 01/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 WILSON TER
GLENDALE CA
91206-4007
US

IV. Provider business mailing address

1509 WILSON TER
GLENDALE CA
91206-4007
US

V. Phone/Fax

Practice location:
  • Phone: 818-409-8000
  • Fax: 818-546-5642
Mailing address:
  • Phone: 818-409-8000
  • Fax: 818-546-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberQ2057
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: