Provider Demographics
NPI:1659453140
Name:WOODLAND HILLS MEDICAL CLINIC II INC.
Entity Type:Organization
Organization Name:WOODLAND HILLS MEDICAL CLINIC II INC.
Other - Org Name:ANN RYAN MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:REZA
Authorized Official - Last Name:MIRSHOJAE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:818-274-4609
Mailing Address - Street 1:5995 TOPANGA CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-3623
Mailing Address - Country:US
Mailing Address - Phone:818-340-3636
Mailing Address - Fax:818-340-9241
Practice Address - Street 1:5995 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-3623
Practice Address - Country:US
Practice Address - Phone:818-340-3636
Practice Address - Fax:818-340-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20183Medicare PIN