Provider Demographics
NPI:1902462047
Name:HARIRI, AMIR H
Entity Type:Individual
Prefix:
First Name:AMIR
Middle Name:H
Last Name:HARIRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11218 LA MAIDA ST APT 201
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-4595
Mailing Address - Country:US
Mailing Address - Phone:818-651-1535
Mailing Address - Fax:
Practice Address - Street 1:9702 STANTON DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-3555
Practice Address - Country:US
Practice Address - Phone:818-651-1535
Practice Address - Fax:818-214-8757
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-14
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY301299207WX0107X
VA0101266811207WX0107X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist