Provider Demographics
NPI:1164942769
Name:TEHRANI, SIAMAK
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:TEHRANI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:SIAMAK
Other - Middle Name:
Other - Last Name:TEHRANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:10538 EASTBORNE AVE #204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-773-2226
Mailing Address - Fax:
Practice Address - Street 1:6007 LANKERSHIM BLVD STE 7
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-4883
Practice Address - Country:US
Practice Address - Phone:818-763-7007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-23
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH68798183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty