Provider Demographics
NPI:1184824146
Name:RAMIN GANJIANPOUR, M.D., INC.
Entity Type:Organization
Organization Name:RAMIN GANJIANPOUR, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DILUIGI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-361-0136
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1200
Mailing Address - Country:US
Mailing Address - Phone:818-361-0136
Mailing Address - Fax:818-365-1259
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 241
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1200
Practice Address - Country:US
Practice Address - Phone:818-361-0136
Practice Address - Fax:818-365-1259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1447274782OtherNPI
CAWA75503BOtherMEDICARE
CA5060920001Medicare NSC
CAWA75503BOtherMEDICARE
CAW17030Medicare PIN