Provider Demographics
NPI:1992992366
Name:YAMINI, SYAMAK (DPM)
Entity type:Individual
Prefix:
First Name:SYAMAK
Middle Name:
Last Name:YAMINI
Suffix:
Gender:
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18700 EDLEEN DR
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4809
Mailing Address - Country:US
Mailing Address - Phone:818-837-5637
Mailing Address - Fax:310-400-5666
Practice Address - Street 1:11145 TAMPA AVE STE 10B
Practice Address - Street 2:
Practice Address - City:PORTER RANCH
Practice Address - State:CA
Practice Address - Zip Code:91326
Practice Address - Country:US
Practice Address - Phone:818-336-1356
Practice Address - Fax:310-400-5666
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4835213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992992366Medicaid
CA1992992366Medicare UPIN
CA1992992366Medicare Oscar/Certification
CA1992992366Medicare NSC
CA1992992366Medicaid