Provider Demographics
NPI:1598250052
Name:KAJANI, SURINA (MD)
Entity Type:Individual
Prefix:
First Name:SURINA
Middle Name:
Last Name:KAJANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 W OLYMPIC BLVD APT 1902
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-1681
Mailing Address - Country:US
Mailing Address - Phone:510-789-3485
Mailing Address - Fax:
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE STE 100
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2496
Practice Address - Country:US
Practice Address - Phone:510-789-3485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-27
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA000000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty