Provider Demographics
NPI:1821104274
Name:YAGHMAI, AMY AMENEH (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:AMENEH
Last Name:YAGHMAI
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 1:2336 SANTA MONICA BLVD
Mailing Address - Street 2:STE 206
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2095
Mailing Address - Country:US
Mailing Address - Phone:310-828-7226
Mailing Address - Fax:310-828-4426
Practice Address - Street 1:2336 SANTA MONICA BLVD
Practice Address - Street 2:STE 206
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2095
Practice Address - Country:US
Practice Address - Phone:310-828-7226
Practice Address - Fax:310-828-4426
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2226384174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist