Provider Demographics
NPI:1366475329
Name:DAYANIM, EHSAN ESI (LAC)
Entity Type:Individual
Prefix:MR
First Name:EHSAN
Middle Name:ESI
Last Name:DAYANIM
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15750 MORRISON ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1544
Mailing Address - Country:US
Mailing Address - Phone:818-981-6132
Mailing Address - Fax:818-500-7013
Practice Address - Street 1:540 N CENTRAL AVE
Practice Address - Street 2:#203
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1916
Practice Address - Country:US
Practice Address - Phone:818-500-7113
Practice Address - Fax:818-500-7013
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0045691Other45691
CAAC0045690Medicaid
CAAC0045692Other45692