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NPI Code Detail

MEDICARE: TANAZ A KERMANI M.D.

MEDICARE: TANAZ A KERMANI 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
1207RR0500XRheumatology Physician47693MN
2207RR0500XRheumatology PhysicianA118919CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11720068448OTHERCACCS PANELED
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720068448
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANAZ A KERMANI M.D.
Provider Business Mailing Address
First Line : 2020 SANTA MONICA BLVD
Second Line : SUITE 540
City : SANTA MONICA
State : CA
Zip : 90404-2023
Country : US
Telephone Number : 310-582-6350
Fax Number : 310-582-6352
Provider Business Practice Location Address
First Line : 2020 SANTA MONICA BLVD
Second Line : SUITE 540
City : SANTA MONICA
State : CA
Zip : 90404-2023
Country : US
Telephone Number : 310-582-6350
Fax Number : 310-582-6352
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 11/01/2012

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Directions to “ TANAZ A KERMANI M.D.” Practice Location

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