Provider Demographics
NPI:1265489546
Name:JAMSHIDINIA, KAMRAN (DPM, FACFAS)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:JAMSHIDINIA
Suffix:
Gender:M
Credentials:DPM, FACFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16600
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2600
Mailing Address - Country:US
Mailing Address - Phone:310-247-9255
Mailing Address - Fax:310-247-9240
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1208
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-247-9255
Practice Address - Fax:310-247-9240
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4331213EP0504X, 213ER0200X, 213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP0504XPodiatric Medicine & Surgery Service ProvidersPodiatristPublic Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU86783Medicare UPIN
CAE4331Medicare PIN
CA5769320001Medicare NSC