Provider Demographics
NPI:1952824872
Name:NIA, HAMID EHSANI (DO)
Entity Type:Individual
Prefix:DR
First Name:HAMID
Middle Name:EHSANI
Last Name:NIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 DOWN HILL RUN
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-1021
Mailing Address - Country:US
Mailing Address - Phone:818-357-0976
Mailing Address - Fax:
Practice Address - Street 1:21835 VENTURA BLVD STE 21837
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1838
Practice Address - Country:US
Practice Address - Phone:818-600-7348
Practice Address - Fax:888-972-1912
Is Sole Proprietor?:No
Enumeration Date:2017-07-23
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10748200207P00000X
NY308858207P00000X
390200000X
CA20A20175207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program