Provider Demographics
NPI:1578517033
Name:ENCINO FAMILY HEALTH ASSOCIATES, INC
Entity Type:Organization
Organization Name:ENCINO FAMILY HEALTH ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ADIBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-808-0037
Mailing Address - Street 1:16661 VENTURA BLVD
Mailing Address - Street 2:SUITE #820
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-1914
Mailing Address - Country:US
Mailing Address - Phone:818-808-0037
Mailing Address - Fax:818-808-0039
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE #820
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-808-0037
Practice Address - Fax:818-808-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI00310Medicare UPIN
CAA64723Medicare ID - Type Unspecified
CAA64723Medicare PIN