MEDICARE: MR. IRFAN AHSAN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	213E00000X	Podiatrist	DPM200072	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124463179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IRFAN AHSAN DPM

Provider Business Mailing Address
First Line	:	8510 BALBOA BLVD STE 150
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-5810
Country	:	US
Telephone Number	:	818-654-3400
Fax Number	:	818-654-3417

Provider Business Practice Location Address
First Line	:	191 S BUENA VISTA ST STE 235
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4563
Country	:	US
Telephone Number	:	818-980-9393
Fax Number	:	818-654-3417

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/30/2019

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Directions to “ MR. IRFAN AHSAN DPM” Practice Location

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