Healthcare Provider Details

I. General information

NPI: 1609253566
Provider Name (Legal Business Name): SINAI PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 04/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S ALMONT DR
LOS ANGELES CA
90048-2910
US

IV. Provider business mailing address

151 S ALMONT DR
LOS ANGELES CA
90048-2910
US

V. Phone/Fax

Practice location:
  • Phone: 310-980-9535
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA113978
License Number StateCA

VIII. Authorized Official

Name: SHAHROUZ DANIEL GANJIAN
Title or Position: DIRECTOR
Credential:
Phone: 310-980-9535