Provider Demographics
NPI:1689954513
Name:EMAMI, SINA (MD)
Entity Type:Individual
Prefix:
First Name:SINA
Middle Name:
Last Name:EMAMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SINA
Other - Middle Name:
Other - Last Name:EMAMIMOGHADAM TEHRANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:15503 VENTURA BLVD, STE 170
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-783-0004
Mailing Address - Fax:818-783-0007
Practice Address - Street 1:15503 VENTURA BLVD, STE 170
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-783-0004
Practice Address - Fax:818-783-0007
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142845207RN0300X, 207R00000X
282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No282N00000XHospitalsGeneral Acute Care Hospital