Provider Demographics
NPI:1093027740
Name:SALEHIAN, SEPAND (MD)
Entity Type:Individual
Prefix:DR
First Name:SEPAND
Middle Name:
Last Name:SALEHIAN
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 1:1509 WILSON TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4007
Mailing Address - Country:US
Mailing Address - Phone:818-409-8000
Mailing Address - Fax:818-546-5642
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-409-8000
Practice Address - Fax:818-546-5642
Is Sole Proprietor?:No
Enumeration Date:2010-07-10
Last Update Date:2018-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ20572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA266420OtherMEDICARE CA
CA4623455OtherCIGNA
CAP01875866OtherRAILROAD
CACA266396OtherMEDICARE CA
CACB278586OtherMEDICARE CA