Provider Demographics
NPI:1558465708
Name:KAMJOO, KAMYAR (MD)
Entity type:Individual
Prefix:
First Name:KAMYAR
Middle Name:
Last Name:KAMJOO
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 1:18370 BURBANK BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2853
Mailing Address - Country:US
Mailing Address - Phone:818-578-7167
Mailing Address - Fax:818-602-4498
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-578-7167
Practice Address - Fax:818-602-4498
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-09
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77563207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI06855Medicare UPIN
CAWA77563BMedicare PIN