Provider Demographics
NPI:1871911909
Name:RAD, AMIR ELIJAH (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:ELIJAH
Last Name:RAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AMIR
Other - Middle Name:
Other - Last Name:ROWSHANRAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:16661 VENTURA BLVD STE 707
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4825
Mailing Address - Country:US
Mailing Address - Phone:818-825-7603
Mailing Address - Fax:323-381-5970
Practice Address - Street 1:16661 VENTURA BLVD STE 707
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4825
Practice Address - Country:US
Practice Address - Phone:818-825-7603
Practice Address - Fax:323-381-5970
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293553207L00000X
390200000X
CAA156434207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty