Provider Demographics
NPI:1073759288
Name:AMIRJAHED, ASHA K (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:K
Last Name:AMIRJAHED
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16927 VANOWEN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406-4591
Mailing Address - Country:US
Mailing Address - Phone:818-342-0701
Mailing Address - Fax:818-342-0702
Practice Address - Street 1:16927 VANOWEN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-4591
Practice Address - Country:US
Practice Address - Phone:818-342-0701
Practice Address - Fax:818-342-0702
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41879208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41879OtherLICENCE