Provider Demographics
NPI:1821266008
Name:EBRAHIMI, KAMYAR YEHUDAH (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMYAR
Middle Name:YEHUDAH
Last Name:EBRAHIMI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1577 E CHEVY CHASE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91206-4192
Mailing Address - Country:US
Mailing Address - Phone:818-246-3300
Mailing Address - Fax:818-246-3305
Practice Address - Street 1:1577 E CHEVY CHASE DR STE 100
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4192
Practice Address - Country:US
Practice Address - Phone:818-246-3300
Practice Address - Fax:818-246-3305
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-11
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA91899208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology