Provider Demographics
NPI:1659394633
Name:RADNIA, DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:RADNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12409 TEXAS AVE
Mailing Address - Street 2:APT 09
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1970
Mailing Address - Country:US
Mailing Address - Phone:310-985-4124
Mailing Address - Fax:310-652-9292
Practice Address - Street 1:1016 S ROBERTSON BLVD
Practice Address - Street 2:101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1505
Practice Address - Country:US
Practice Address - Phone:310-985-4124
Practice Address - Fax:310-652-9292
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92103208D00000X
CA92103207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A921030Medicaid
CAA92103Medicare ID - Type Unspecified
CAI41938Medicare UPIN