Healthcare Provider Details

I. General information

NPI: 1356897573
Provider Name (Legal Business Name): SANI AND ESHAGHIAN M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST SUITE #205
NORTHRIDGE CA
91325-1600
US

IV. Provider business mailing address

17075 DEVONSHIRE ST SUITE #205
NORTHRIDGE CA
91325-1600
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-2977
  • Fax:
Mailing address:
  • Phone: 818-366-2977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA111635
License Number StateCA

VIII. Authorized Official

Name: DR. BABAK ESHAGHIAN
Title or Position: PHYSICIAN
Credential: M.D,
Phone: 818-366-2977