Healthcare Provider Details

I. General information

NPI: 1144480252
Provider Name (Legal Business Name): KAMYAR AMINI MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 07/12/2025
Certification Date: 07/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14600 SHERMAN WAY STE 250
VAN NUYS CA
91405-2284
US

IV. Provider business mailing address

14600 SHERMAN WAY STE 250
VAN NUYS CA
91405-2284
US

V. Phone/Fax

Practice location:
  • Phone: 818-998-6600
  • Fax: 818-495-4031
Mailing address:
  • Phone: 818-998-6600
  • Fax: 818-495-4031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA99444
License Number StateCA

VIII. Authorized Official

Name: SALOUMEH YARAGHCHI
Title or Position: PRACTICE MANAGER
Credential:
Phone: 310-709-6604