Provider Demographics
NPI:1104851807
Name:SENAATI, SASSAN (MD)
Entity Type:Individual
Prefix:
First Name:SASSAN
Middle Name:
Last Name:SENAATI
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA664862085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A664860OtherBLUE SHIELD
CAGR0106039Medicaid
CA00A664860Medicaid
CAGR0106035Medicaid
CAH82791Medicare UPIN
CA00A664860Medicaid
CAWA66486FMedicare PIN
CA00A664860OtherBLUE SHIELD
CAWA66486DMedicare PIN
CAAP097XMedicare PIN
CAWA66486HMedicare PIN
CAWA66486AMedicare PIN
CAGR0106039Medicaid
CAAP097ZMedicare PIN
CAWA66486BMedicare PIN
CAWA66486JMedicare PIN