Healthcare Provider Details

I. General information

NPI: 1609198779
Provider Name (Legal Business Name): AMBOOJ TIWARI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

1511 3RD AVE STE 1000
SEATTLE WA
98101-3637
US

V. Phone/Fax

Practice location:
  • Phone: 818-365-8051
  • Fax: 818-897-4701
Mailing address:
  • Phone: 408-508-6218
  • Fax: 408-351-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number25MA09637400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number276012-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA09637400
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number276012-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: