Provider Demographics
NPI:1548759046
Name:KAZEROONI, LEILA ZAHRA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEILA
Middle Name:ZAHRA
Last Name:KAZEROONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LEILA
Other - Middle Name:ZAHRA
Other - Last Name:BAHMANI KAZEROONI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6344 TOPANGA CANYON BLVD STE 2040
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-2362
Practice Address - Country:US
Practice Address - Phone:818-610-0292
Practice Address - Fax:818-610-0293
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA179920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program