Healthcare Provider Details

I. General information

NPI: 1730265703
Provider Name (Legal Business Name): JILA DAYANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR #101
VALLEY VILLAGE CA
91607
US

IV. Provider business mailing address

12626 RIVERSIDE DR #101
VALLEY VILLAGE CA
91607
US

V. Phone/Fax

Practice location:
  • Phone: 818-766-7640
  • Fax: 818-752-1748
Mailing address:
  • Phone: 818-766-7640
  • Fax: 818-752-1748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA052716
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: