Provider Demographics
NPI:1497782387
Name:SAFVATI, KAMRAN (MD)
Entity Type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:SAFVATI
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:PO BOX 573219
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-3219
Mailing Address - Country:US
Mailing Address - Phone:818-609-1991
Mailing Address - Fax:818-609-1949
Practice Address - Street 1:18356 CLARK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3502
Practice Address - Country:US
Practice Address - Phone:818-609-1991
Practice Address - Fax:818-609-1949
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66831174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH29782Medicare UPIN
CAWA66831BMedicare PIN