Healthcare Provider Details

I. General information

NPI: 1447695325
Provider Name (Legal Business Name): ADITYA KRISHNA IYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2013
Last Update Date: 02/16/2024
Certification Date: 02/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11550 INDIAN HILLS RD STE 261
MISSION HILLS CA
91345-1244
US

IV. Provider business mailing address

2020 SANTA MONICA BLVD FL 3
SANTA MONICA CA
90404-2023
US

V. Phone/Fax

Practice location:
  • Phone: 818-847-6570
  • Fax: 310-582-7495
Mailing address:
  • Phone: 310-829-8868
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA131842
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA131842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: