Provider Demographics
NPI:1073615233
Name:TARZANA GARDEN OB GYN
Entity Type:Organization
Organization Name:TARZANA GARDEN OB GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SID
Authorized Official - Middle Name:
Authorized Official - Last Name:KAMRAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-345-6650
Mailing Address - Street 1:18411 CLARK ST
Mailing Address - Street 2:301
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356
Mailing Address - Country:US
Mailing Address - Phone:818-345-6600
Mailing Address - Fax:818-705-0035
Practice Address - Street 1:18411 CLARK ST
Practice Address - Street 2:301
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-345-6600
Practice Address - Fax:818-705-0035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34548207V00000X
CAG41227207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A345480Medicaid
CA00A345480Medicaid
A27510Medicare UPIN