Provider Demographics
NPI:1346563988
Name:AMERICAN MEDICAL ASSOCIATES FOR HEALTH ADVANCEMENT, INC.
Entity Type:Organization
Organization Name:AMERICAN MEDICAL ASSOCIATES FOR HEALTH ADVANCEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / MEDICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:SAEEDIAN
Authorized Official - Last Name:KANGARLU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-721-4169
Mailing Address - Street 1:9025 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1831
Mailing Address - Country:US
Mailing Address - Phone:310-721-4169
Mailing Address - Fax:
Practice Address - Street 1:9025 WILSHIRE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1831
Practice Address - Country:US
Practice Address - Phone:310-721-4169
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA74483208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA74483Medicaid