Active NPI
Khosrow Sadrieh, M.D.
- Specialist
- Sherman Oaks, CA
National Provider Identifier
1487735692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- A29572
- Practice address
- 4910 Van Nuys Blvd
110
Sherman Oaks, CA 91403-1782 - Phone
- (818) 986-8215
- Fax
- (818) 986-9582
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | A29572 | CA | Primary |
Addresses
Primary practice location
4910 Van Nuys Blvd
110
Sherman Oaks, CA 91403-1782
Mailing address
4910 Van Nuys Blvd
110
Sherman Oaks, CA 91403-1782
Phone (818) 986-8215
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ48958Z | Other | CA | BLUE SHIELD PROVIDER # |
| ZZZ97621Z | Other | CA | BLUE CROSS PROVIDER # |
| 00A295720 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Glendale Diagnostic Imaging Network Medical Office, Inc | Single Specialty | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Glendale, CA
- NPI 1902814759
Single Specialty
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1487735692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4910 VAN NUYS BLVD",
"address_2": "110",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914031782",
"telephone_number": "818-986-8215",
"fax_number": "818-986-9582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4910 VAN NUYS BLVD",
"address_2": "110",
"city": "SHERMAN OAKS",
"state": "CA",
"postal_code": "914031782",
"telephone_number": "818-986-8215",
"fax_number": "818-986-9582"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SADRIEH",
"first_name": "KHOSROW",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Specialist",
"state": "CA",
"license": "A29572",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD PROVIDER #",
"identifier": "ZZZ48958Z",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS PROVIDER #",
"identifier": "ZZZ97621Z",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A295720",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sherman Oaks, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.