Individual provider Active NPI

Ashkan Imanzahrai, MD

  • Hospice and Palliative Medicine (Family Medicine) Physician
  • Woodland Hills, CA
National Provider Identifier
1205944907
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospice and Palliative Medicine (Family Medicine) PhysicianTaxonomy code 207QH0002X
License
A55704 Issued in CA
Practice address
5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone
(818) 719-2020
Fax
(818) 306-9720
NPI assigned
Aug 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A55704 CA
Hospice and Palliative Medicine (Family Medicine) Physician 207QH0002X A55704 CA Primary

Addresses

Primary practice location

5601 De Soto Ave
Woodland Hills, CA 91367-6701

Mailing address

2625 E Divisadero St
Fresno, CA 93721-1431
Phone (559) 443-2682

Other identifiers 1

IdentifierTypeStateIssuer
00A557040MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051219000337 CA Practitioner - Hospice/Palliative CarePractitioner - Family PracticePractitioner - Geriatric Medicine 7618998683 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hospice/Palliative CareAlso: Geriatric Medicine
Education
Loyola University of Chicago, Stritch School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern California Permanente Medical GroupGroup PAC ID 6002729175, 11,250 clinicians

Practice addresses (Care Compare)

20940 Burbank Blvd
Woodland Hills, CA 91367-6601
Phone (888) 515-3500

5601 De Soto Ave
Woodland Hills, CA 91367-6701
Phone (818) 719-2000

Hospital & facility affiliations

  • Kaiser Foundation Hospital - Woodland Hills Hospital, Woodland Hills, CA, CCN 050677

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A55704CAMDHospice and Palliative Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern California Permanente Medical Group CurrentSince May 24, 2016 Accepting new patients
Southern California Permanente Medical Group CurrentSince May 24, 2016 Accepting new patients
Southern California Permanente Medical Group Current Accepting new patients
Central California Faculty Medical Group, Inc. Family Medicine Past Accepting new patients

Locations

393 E Walnut St
Unit 3RD
Pasadena, CA 91188
Phone (626) 405-7914

5601 De Soto Ave
Woodland Hls, CA 91367
Phone (818) 719-2000

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1156464000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692662400000",
    "number": "1205944907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5601 DE SOTO AVE",
            "city": "WOODLAND HILLS",
            "state": "CA",
            "postal_code": "913676701",
            "telephone_number": "818-719-2020",
            "fax_number": "818-306-9720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IMANZAHRAI",
        "first_name": "ASHKAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-25",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A55704",
            "primary": false
        },
        {
            "code": "207QH0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Hospice and Palliative Medicine",
            "state": "CA",
            "license": "A55704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A557040",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "5601 De Soto Ave",
            "city": "Woodland Hills",
            "state": "CA",
            "country_code": "US",
            "postal_code": "913676701",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Woodland Hills, CA

Sources for this page

Verify at the official NPI Registry.