Healthcare Provider Details

I. General information

NPI: 1962563734
Provider Name (Legal Business Name): WOODLAND HILLS MEDICAL CLINIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19825 VENTURA BLVD
WOODLAND HILLS CA
91364-2627
US

IV. Provider business mailing address

5995 TOPANGA CANYON BLVD
WOODLAND HILLS CA
91367-3623
US

V. Phone/Fax

Practice location:
  • Phone: 818-340-3636
  • Fax:
Mailing address:
  • Phone: 818-888-7009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number20A6577
License Number StateCA

VIII. Authorized Official

Name: DR. HAMID MIRSHOJAE
Title or Position: DIRECTOR
Credential: DO
Phone: 818-340-3636