Healthcare Provider Details

I. General information

NPI: 1467673699
Provider Name (Legal Business Name): MICHAEL AURASH ZADEH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14658 VENTURA BLVD
SHERMAN OAKS CA
91403-3618
US

IV. Provider business mailing address

14658 VENTURA BLVD
SHERMAN OAKS CA
91403-3618
US

V. Phone/Fax

Practice location:
  • Phone: 818-789-1111
  • Fax: 818-789-1116
Mailing address:
  • Phone: 818-789-1111
  • Fax: 818-789-1116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA99098
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: