Physician Compare National (NPI:1770680225)

HEALTHCARE PROVIDER:

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1770680225
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749259968
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20040927000270
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	DIMYAN
	Individual professional last name
Provider First Name	SHERIF
	Individual professional first name
Provider Middle Name	A
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	DO
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	AT STILL UNIVERSITY OF HEALTH SCIENCES, COLLEGE OF OSTEO MED, KIRKSVILLE
	Individual professional's medical school
Graduation Year	1992
	Individual professional's medical school graduation year
Primary Specialty	NEUROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	PAIN MANAGEMENT
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	PAIN MANAGEMENT
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Line 1 Street Address	1141 W REDONDO BEACH BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 207
	Group Practice or individual's line 2 address
City	GARDENA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	902473584
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	050426
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	WEST ANAHEIM MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	050580
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	LA PALMA INTERCOMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	050226
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	AHMC ANAHEIM REGIONAL MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	050468
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	MEMORIAL HOSPITAL OF GARDENA
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	050776
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	COLLEGE MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1770680225)

HEALTHCARE PROVIDER:

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information