Provider Demographics
NPI:1730245358
Name:ZAMANI, SIAMAK (MD)
Entity type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ZAMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 844842
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90084-4842
Mailing Address - Country:US
Mailing Address - Phone:800-478-6675
Mailing Address - Fax:866-877-6813
Practice Address - Street 1:29873 SANTA MARGARITA PKWY
Practice Address - Street 2:STE 100
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-3626
Practice Address - Country:US
Practice Address - Phone:949-589-9114
Practice Address - Fax:949-421-0763
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA93944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB225317Medicare PIN