Provider Demographics
NPI:1336271055
Name:FERIDOUNI, SYRUS (MD)
Entity Type:Individual
Prefix:
First Name:SYRUS
Middle Name:
Last Name:FERIDOUNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 S CHEVY CHASE DR STE 250
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4433
Mailing Address - Country:US
Mailing Address - Phone:818-265-2264
Mailing Address - Fax:818-265-2263
Practice Address - Street 1:801 S CHEVY CHASE DR STE 250
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4433
Practice Address - Country:US
Practice Address - Phone:818-265-2264
Practice Address - Fax:818-265-2263
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97912207Q00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine