Provider Demographics
NPI:1114724846
Name:KAMYAR, NASIM
Entity type:Individual
Prefix:
First Name:NASIM
Middle Name:
Last Name:KAMYAR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9915 VARIEL AVE UNIT 16
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-6729
Mailing Address - Country:US
Mailing Address - Phone:818-809-6370
Mailing Address - Fax:
Practice Address - Street 1:9915 VARIEL AVE UNIT 16
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6729
Practice Address - Country:US
Practice Address - Phone:818-809-6370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-28
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant