Provider Demographics
NPI:1447274782
Name:GANJIANPOUR, RAMIN (MD)
Entity type:Individual
Prefix:
First Name:RAMIN
Middle Name:
Last Name:GANJIANPOUR
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 1:11550 INDIAN HILLS RD STE 241
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1202
Mailing Address - Country:US
Mailing Address - Phone:818-361-0136
Mailing Address - Fax:818-365-1259
Practice Address - Street 1:11550 INDIAN HILLS RD STE 241
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1202
Practice Address - Country:US
Practice Address - Phone:818-361-0136
Practice Address - Fax:818-365-1259
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA755503174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH56424Medicare UPIN
CAWA75503BMedicare ID - Type Unspecified