Siamak Etehad MD Inc a Medical Corporation

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SIAMAK ETEHAD MD INC A MEDICAL CORPORATION

Practice address

17075 Devonshire St
#100
Northridge, CA 91325-1600

Phone

(818) 363-2077

Fax

(818) 363-2055

NPI assigned

Jun 3, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Siamak P Etehad, MDNPI 1184728479

Title

President

Phone

(800) 673-8185

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Center for Family Health and Education Inc

  • Federally Qualified Health Center (FQHC)
  • Panorama City, CA
  • NPI 1871853481

  O20140702002303

  Same enrollment

Tax ID family

Siamak Etehad MD Inc a Medical Corporation3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Center for Family Health and Education Inc

  • Federally Qualified Health Center (FQHC)
  • Panorama City, CA
  • NPI 1871853481
  NPD tax ID
• Siamak Etehad, MD, Inc. a Medical Corporation

  • Internal Medicine Physician
  • Northridge, CA
  • NPI 1730516303
  NPD tax ID

Networks

• BSC 65 PLUS INDIVIDUAL MAPDPlans: Blue Shield 65 Plus (HMO) (H0504-015-000, H0504); Blue Shield 65 Plus (HMO) (H0504-039-000, H0504); Blue Shield 65 Plus Plan 2 (HMO) (H0504-021-000, H0504); Blue Shield Inspire (HMO) (H0504-041-000, H0504); Blue Shield 65 Plus (HMO) (H0504-038-000, H0504); Blue Shield Inspire (HMO) (H0504-047-000, H0504); Blue Shield 65 Plus (HMO) (H0504-026-000, H0504); Blue Shield Advantage (HMO) (H0504-050-000, H0504); Blue Shield AdvantageOptimum Plan (HMO) (H5928-004-000, H5928); Blue Shield Inspire (HMO) (H0504-043-000, H0504)…

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Siamak P Etehad, MD

  • Internal Medicine Physician
  • Northridge, CA
  • NPI 1184728479
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1370217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388793600000",
    "number": "1043657802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 280636",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913280636",
            "telephone_number": "818-363-2077",
            "fax_number": "818-363-2055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST",
            "address_2": "#100",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913251600",
            "telephone_number": "818-363-2077",
            "fax_number": "818-363-2055"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIAMAK ETEHAD MD INC A MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-03",
        "last_updated": "2014-01-04",
        "status": "A",
        "authorized_official_last_name": "ETEHAD",
        "authorized_official_first_name": "SIAMAK",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-673-8185",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cherie A Short, PA
• Vivian Shoukrun, MD
• Ellen Shuham, OD
• Mitchell C Shultz, M.D.
• Kaili Ji Shumilak, D.O.
• Siamak Etehad, MD, Inc. a Medical Corporation
• Jenny R Siaw
• Amanda Sibley, N.P.
• Sanbir Singh Sidhu, M.D
• Isis Sierra

• Internal Medicine Physician in Northridge, CA
• Providers in Northridge, CA by specialty
• Internal Medicine Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.