Provider Demographics
NPI:1962669119
Name:ASHA AMIRJAHED MD
Entity type:Organization
Organization Name:ASHA AMIRJAHED MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHA
Authorized Official - Middle Name:KOOROSH
Authorized Official - Last Name:AMIRJAHED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-757-3400
Mailing Address - Street 1:7035 RESEDA BLVD
Mailing Address - Street 2:SUITE #B
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335
Mailing Address - Country:US
Mailing Address - Phone:818-757-3400
Mailing Address - Fax:818-757-3405
Practice Address - Street 1:7035 RESEDA BLVD
Practice Address - Street 2:SUITE #B
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335
Practice Address - Country:US
Practice Address - Phone:818-757-3400
Practice Address - Fax:818-757-3405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41879OtherCA LICENCE