Active NPI
Siamak Etehad, MD, Inc. a Medical Corporation
- Internal Medicine Physician
- Northridge, CA
National Provider Identifier
1730516303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- A43714
- Legal business name
- SIAMAK ETEHAD, MD, INC. A MEDICAL CORPORATION
- Practice address
- 17075 Devonshire St Ste 100
Northridge, CA 91325-5405 - Phone
- (800) 673-8185
- Fax
- (310) 626-9765
- NPI assigned
- Sep 27, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Siamak Pour Etehad, MD
- Title
- President
- Phone
- (800) 673-8185
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | A43714 | CA | Primary |
Addresses
Primary practice location
17075 Devonshire St Ste 100
Northridge, CA 91325-5405
Mailing address
PO Box 280636
Northridge, CA 91328-0636
Phone (800) 673-8185
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A437140 | Medicaid | CA |
National Provider Directory
National Provider Directory- Tax ID family
- Siamak Etehad MD Inc a Medical Corporation
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Federally Qualified Health Center (FQHC)
- Panorama City, CA
- NPI 1871853481
-
- Internal Medicine Physician
- Northridge, CA
- NPI 1043657802
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Internal Medicine Physician
- Northridge, CA
- NPI 1184728479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380240000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1380240000000",
"number": "1730516303",
"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": "800-673-8185"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17075 DEVONSHIRE ST STE 100",
"city": "NORTHRIDGE",
"state": "CA",
"postal_code": "913255405",
"telephone_number": "800-673-8185",
"fax_number": "310-626-9765"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SIAMAK ETEHAD, MD, INC. A MEDICAL CORPORATION",
"organizational_subpart": "NO",
"enumeration_date": "2013-09-27",
"last_updated": "2013-09-27",
"status": "A",
"authorized_official_last_name": "ETEHAD",
"authorized_official_first_name": "SIAMAK",
"authorized_official_middle_name": "POUR",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "800-673-8185",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY 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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.