Provider Demographics
NPI:1184867624
Name:H G ZIAEE MD CORP
Entity Type:Organization
Organization Name:H G ZIAEE MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOSSEINGHOLI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZIAEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-342-5771
Mailing Address - Street 1:5258 NEWCASTLE AVE
Mailing Address - Street 2:# 20
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3078
Mailing Address - Country:US
Mailing Address - Phone:818-342-5771
Mailing Address - Fax:818-342-5771
Practice Address - Street 1:12212 W WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-5508
Practice Address - Country:US
Practice Address - Phone:310-391-5241
Practice Address - Fax:310-397-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-14
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA89604208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty