Healthcare Provider Details

I. General information

NPI: 1790701548
Provider Name (Legal Business Name): S. JALALI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 09/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15107 VANOWEN ST
VAN NUYS CA
91405-4542
US

IV. Provider business mailing address

101 S 1ST ST SUITE 1000
BURBANK CA
91502-1938
US

V. Phone/Fax

Practice location:
  • Phone: 818-784-6600
  • Fax: 818-904-3774
Mailing address:
  • Phone: 818-845-6206
  • Fax: 626-396-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA82712
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA82712
License Number StateCA

VIII. Authorized Official

Name: SHAHRAM JALALI
Title or Position: SOLE OWNER
Credential: M.D.
Phone: 818-513-1213