Healthcare Provider Details

I. General information

NPI: 1457230625
Provider Name (Legal Business Name): DELIJANI MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 09/01/2025
Certification Date: 08/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 PACIFIC COAST HWY STE 204
HERMOSA BEACH CA
90254-2227
US

IV. Provider business mailing address

314 N DOHENY DR
BEVERLY HILLS CA
90211-1622
US

V. Phone/Fax

Practice location:
  • Phone: 424-728-5564
  • Fax: 424-728-5564
Mailing address:
  • Phone: 424-728-5564
  • Fax: 424-377-6548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. DYANA KO
Title or Position: PRESIDENT
Credential: NP
Phone: 424-728-5564