Provider Demographics
NPI:1427456151
Name:VAKILIAN, SIAVOSH (MD)
Entity type:Individual
Prefix:
First Name:SIAVOSH
Middle Name:
Last Name:VAKILIAN
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:PO BOX 845996
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-3592
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-221-5036
Practice Address - Street 1:3366 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5713
Practice Address - Country:US
Practice Address - Phone:619-230-0400
Practice Address - Fax:858-429-7936
Is Sole Proprietor?:No
Enumeration Date:2014-12-11
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1334822085R0001X
AZ551332085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB366085OtherMEDICARE PIN
CACB224891Medicare PIN
CACB224890Medicare PIN