=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093807257
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROGER GIANI MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 04/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3444 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-264-2670
-----------------------------------------------------
Fax | 323-265-1152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3444 WHITTIER BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90023-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-264-2670
-----------------------------------------------------
Fax | 323-265-1152
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. IRAJ (ROGER) SADAGHIANI( GIANI)
-----------------------------------------------------
Credential | M.D,
-----------------------------------------------------
Telephone | 323-264-2670
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | A412910
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------