NPIMap

Individual provider Active NPI

Siamak P Etehad, MD

  • Internal Medicine Physician
  • Northridge, CA
National Provider Identifier
1184728479
Registry record updated Feb 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
A43714 Issued in CA
Practice address
17075 Devonshire
#100
Northridge, CA 91325
Phone
(818) 831-7767
Fax
(818) 831-3757
NPI assigned
Sep 8, 2006
Last updated
Feb 20, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X A43714 CA Primary

Addresses

Primary practice location

17075 Devonshire
#100
Northridge, CA 91325

Mailing address

17075 Devonshire St Ste 100
Northridge, CA 91325-5405
Phone (818) 831-7767

Other practice location 1

8727 Van Nuys Blvd Ste 101102
Van Nuys, CA 91402-2451
Phone (818) 812-5410

Other identifiers 1

IdentifierTypeStateIssuer
00A437140MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120420000336 CA Practitioner - Internal Medicine 6204097108 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1980
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

17075 Devonshire St
Suite 100
Northridge, CA 91325-5405
Phone (818) 363-2077

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A43714CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Siamak Etehad, MD, Inc. a Medical Corporation Internal Medicine Current Accepting new patients
Deanco Healthcare LLC. Past Accepting new patients
Center for Family Health and Education Inc Past Accepting new patients
Dignity Community Care Past Accepting new patients
Providence Health System - Southern California Past Accepting new patients

Locations

17075 Devonshire St
Ste 100
Northridge, CA 91325
Phone (800) 673-8185

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Casitas Care CenterGranada Hills, CA, CCN 056148 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Sep 28, 2011
Sep 28, 2011
Pristine Hospice CareBurbank, CA, CCN 921755 Hospice Contracted Managing Employee Aug 20, 2024
Highland Hospice IncChatsworth, CA, CCN A11767 Hospice Contracted Managing Employee Apr 1, 2024

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1157673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771545600000",
    "number": "1184728479",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE ST STE 100",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "913255405",
            "telephone_number": "818-831-7767",
            "fax_number": "818-831-3757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17075 DEVONSHIRE",
            "address_2": "#100",
            "city": "NORTHRIDGE",
            "state": "CA",
            "postal_code": "91325",
            "telephone_number": "818-831-7767",
            "fax_number": "818-831-3757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8727 Van Nuys Blvd Ste 101102",
            "address_purpose": "LOCATION",
            "city": "Van Nuys",
            "state": "CA",
            "postal_code": "914022451",
            "country_code": "US",
            "telephone_number": "818-812-5410",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETEHAD",
        "first_name": "SIAMAK",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-08",
        "last_updated": "2026-02-20",
        "certification_date": "2026-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "A43714",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A437140",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Northridge, CA

Sources for this page

Verify at the official NPI Registry.