Provider Demographics
NPI:1144065236
Name:LEGACY HEALTH INC
Entity type:Organization
Organization Name:LEGACY HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAAHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-620-2485
Mailing Address - Street 1:18350 ROSCOE BLVD STE 218
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4153
Mailing Address - Country:US
Mailing Address - Phone:818-620-2485
Mailing Address - Fax:
Practice Address - Street 1:18350 ROSCOE BLVD STE 218
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4153
Practice Address - Country:US
Practice Address - Phone:818-620-2485
Practice Address - Fax:818-993-8158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780245985OtherNPI