MEDICARE: DR. DANIEL RADNIA M.D.

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	208D00000X	General Practice Physician	A92103	CA
2	207QA0401X	Addiction Medicine (Family Medicine) Physician	92103	CA

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

General Provider Information

NPI Number	:	1659394633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL RADNIA M.D.

Provider Business Mailing Address
First Line	:	12409 TEXAS AVE
Second Line	:	APT 09
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1970
Country	:	US
Telephone Number	:	310-985-4124
Fax Number	:	310-652-9292

Provider Business Practice Location Address
First Line	:	1016 S ROBERTSON BLVD
Second Line	:	101
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1505
Country	:	US
Telephone Number	:	310-985-4124
Fax Number	:	310-652-9292

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/03/2023

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