Provider Demographics
NPI:1225214554
Name:GLENN R. IRANI, M.D. AND KRISTINE KERN IRANI, M.D., INC.
Entity Type:Organization
Organization Name:GLENN R. IRANI, M.D. AND KRISTINE KERN IRANI, M.D., INC.
Other - Org Name:DRS. GLENN AND KRISTINE IRANI
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:R
Authorized Official - Last Name:IRANI, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-344-7600
Mailing Address - Street 1:5525 ETIWANDA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3647
Mailing Address - Country:US
Mailing Address - Phone:818-344-7600
Mailing Address - Fax:818-996-9709
Practice Address - Street 1:5525 ETIWANDA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3647
Practice Address - Country:US
Practice Address - Phone:818-344-7600
Practice Address - Fax:818-996-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty