Provider Demographics
NPI:1073661807
Name:AKHAVAN, JAMSHEED (MD)
Entity Type:Individual
Prefix:
First Name:JAMSHEED
Middle Name:
Last Name:AKHAVAN
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 1:22030 SHERMAN WAY
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-1844
Mailing Address - Country:US
Mailing Address - Phone:818-312-9101
Mailing Address - Fax:818-312-9100
Practice Address - Street 1:22030 SHERMAN WAY
Practice Address - Street 2:SUITE # 101
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-1844
Practice Address - Country:US
Practice Address - Phone:818-312-9101
Practice Address - Fax:818-312-9100
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47734208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB219985Medicare UPIN