Healthcare Provider Details

I. General information

NPI: 1295998300
Provider Name (Legal Business Name): REZA KERMANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: REZA KERMANI-NEJAD MD

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38920 TRADE CENTER DR
PALMDALE CA
93551-3715
US

IV. Provider business mailing address

35 E GLENARM ST
PASADENA CA
91105-3418
US

V. Phone/Fax

Practice location:
  • Phone: 661-382-0221
  • Fax: 661-940-1066
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number111955
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: