Provider Demographics
NPI:1215272059
Name:KAMYAR KAMJOO MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:KAMYAR KAMJOO MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMYAR
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMJOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-704-6744
Mailing Address - Street 1:PO BOX 572767
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2767
Mailing Address - Country:US
Mailing Address - Phone:310-704-6744
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 714
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:310-704-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty