Provider Demographics
NPI:1598943748
Name:AMIRGHOLAMI, MAHIN (MD)
Entity Type:Individual
Prefix:
First Name:MAHIN
Middle Name:
Last Name:AMIRGHOLAMI
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 1:23101 SHERMAN PL STE 40123101
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:818-888-6545
Mailing Address - Fax:818-593-4563
Practice Address - Street 1:23101 SHERMAN PL STE 302
Practice Address - Street 2:23101 SHERRMAN PLACE#302
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2047
Practice Address - Country:US
Practice Address - Phone:818-888-6545
Practice Address - Fax:818-593-4563
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102266207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACR463ZMedicare PIN