Provider Demographics
NPI:1396330676
Name:BEHMANESH, KIAN (DO)
Entity type:Individual
Prefix:
First Name:KIAN
Middle Name:
Last Name:BEHMANESH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18564 WILLARD ST
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1253
Mailing Address - Country:US
Mailing Address - Phone:818-825-7017
Mailing Address - Fax:
Practice Address - Street 1:18564 WILLARD ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1253
Practice Address - Country:US
Practice Address - Phone:818-825-7017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A22398207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine