Provider Demographics
NPI:1467465344
Name:DANESHGAR, BIJAN (MD)
Entity Type:Individual
Prefix:MR
First Name:BIJAN
Middle Name:
Last Name:DANESHGAR
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 1:16500 VENTURA BLVD
Mailing Address - Street 2:STE 222
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2011
Mailing Address - Country:US
Mailing Address - Phone:818-905-6111
Mailing Address - Fax:818-905-3250
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:STE 222
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-905-6111
Practice Address - Fax:818-905-3250
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30971Medicaid
A-87485Medicare UPIN
AO30971Medicare ID - Type Unspecified