Provider Demographics
NPI:1427007392
Name:SEMNANI, HOOSHANG (MD)
Entity Type:Individual
Prefix:DR
First Name:HOOSHANG
Middle Name:
Last Name:SEMNANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2934 1/2 N BEVERLY GLEN CIR
Mailing Address - Street 2:P.O.BOX 21
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1724
Mailing Address - Country:US
Mailing Address - Phone:818-882-2441
Mailing Address - Fax:818-990-1914
Practice Address - Street 1:18300 ROSCOE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4105
Practice Address - Country:US
Practice Address - Phone:818-885-5349
Practice Address - Fax:818-885-5448
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41158174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0069080Medicaid
CAGR0069080Medicaid