| Siamak Etehad, Md, Inc. A Medical Corporation | |
|
17075 Devonshire St Ste 100 Northridge CA 91325-5405 | |
| (800) 673-8185 | |
| (310) 626-9765 |
| Full Name | Siamak Etehad, Md, Inc. A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 17075 Devonshire St Ste 100, Northridge, California |
| Authorized Official Name and Position | Siamak Pour Etehad (PRESIDENT) |
| Authorized Official Contact | 8006738185 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Siamak Etehad, Md, Inc. A Medical Corporation Po Box 280636 Northridge CA 91328-0636 Ph: (800) 673-8185 | Siamak Etehad, Md, Inc. A Medical Corporation 17075 Devonshire St Ste 100 Northridge CA 91325-5405 Ph: (800) 673-8185 |
| NPI Number | 1730516303 |
|---|---|
| Provider Enumeration Date | 09/27/2013 |
| Last Update Date | 09/27/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730516303 | NPI | - | NPPES |
| 00A437140 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A43714 (California) | Primary |
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