Healthcare Provider Details

I. General information

NPI: 1366351546
Provider Name (Legal Business Name): KAMYAR EBRAHIMI MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1577 E CHEVY CHASE DR STE 100
GLENDALE CA
91206-4192
US

IV. Provider business mailing address

1577 E CHEVY CHASE DR STE 100
GLENDALE CA
91206-4192
US

V. Phone/Fax

Practice location:
  • Phone: 818-246-3300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KAMYAR EBRAHIMI
Title or Position: PRESIDENT
Credential: MD
Phone: 818-246-3300