Provider Demographics
NPI:1235203449
Name:NEJAD, MOHAMMAD REZA KALANTARI (MD)
Entity Type:Individual
Prefix:DR
First Name:MOHAMMAD REZA
Middle Name:KALANTARI
Last Name:NEJAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:NEJAD (NEZHAD)
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-380-9191
Mailing Address - Fax:818-380-9190
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-380-9191
Practice Address - Fax:818-380-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48313207W00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery