Healthcare Provider Details

I. General information

NPI: 1760702179
Provider Name (Legal Business Name): SASAN SANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 12/12/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17075 DEVONSHIRE ST STE 205
NORTHRIDGE CA
91325-5408
US

IV. Provider business mailing address

17075 DEVONSHIRE ST STE 205
NORTHRIDGE CA
91325-5408
US

V. Phone/Fax

Practice location:
  • Phone: 818-366-2977
  • Fax: 818-360-3533
Mailing address:
  • Phone: 818-366-2977
  • Fax: 818-360-3533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA121006
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA121006
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA121006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: