MEDICARE: DR. NOOSHIN NIKNAM PHARM.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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	67689	CA

General Provider Information

NPI Number	:	1710839410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NOOSHIN NIKNAM PHARM.D

Provider Business Mailing Address
First Line	:	17712 MIRANDA ST
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17712 MIRANDA ST
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-1113
Country	:	US
Telephone Number	:	818-613-4944
Fax Number	:

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

Provider Enumeration Date	:	02/13/2026
Last Update Date	:	02/13/2026

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