Provider Demographics
NPI:1124054499
Name:EHYA, ANOUSHIRAVAN (MD)
Entity type:Individual
Prefix:
First Name:ANOUSHIRAVAN
Middle Name:
Last Name:EHYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14516 HAWTHORNE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1519
Mailing Address - Country:US
Mailing Address - Phone:310-219-0890
Mailing Address - Fax:310-219-0297
Practice Address - Street 1:14516 HAWTHORNE BLVD
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1519
Practice Address - Country:US
Practice Address - Phone:310-219-0890
Practice Address - Fax:310-219-0297
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA060345174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA060345OtherMEDICAL LICENSE