Provider Demographics
NPI:1295998300
Name:KERMANI, REZA (MD)
Entity type:Individual
Prefix:DR
First Name:REZA
Middle Name:
Last Name:KERMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:REZA
Other - Middle Name:
Other - Last Name:KERMANI-NEJAD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:35 E GLENARM ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3418
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:38920 TRADE CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-3715
Practice Address - Country:US
Practice Address - Phone:661-382-0221
Practice Address - Fax:661-940-1066
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1119552086S0102X
KY471652086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB242216Medicare PIN