Provider Demographics
NPI:1467836288
Name:HOSSEIN DEHGHANI, MD INC
Entity Type:Organization
Organization Name:HOSSEIN DEHGHANI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HOSSEIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEHGHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-935-4911
Mailing Address - Street 1:1560 E CHEVY CHASE DR STE 445
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4154
Mailing Address - Country:US
Mailing Address - Phone:818-548-2511
Mailing Address - Fax:818-247-7249
Practice Address - Street 1:1560 E CHEVY CHASE DR STE 445
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4154
Practice Address - Country:US
Practice Address - Phone:818-247-3938
Practice Address - Fax:818-247-7249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-10
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 113434207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty