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Provider Information for 1467453282

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

DR. PEGAH DANESHRAD M.D.

Other Name:   PEGAH KHANDABI
Gender: FEMALE

Individual NPI: 1467453282

Calendar   Last Updated:  2007-07-08
  Certification Date: 

Details

Name Value
NPI 1467453282
Enumeration Date 2005-08-02
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 1172 N MACLAY AVE
SAN FERNANDO, CA 91340-1328
United States

Phone: 818-898-1388 | Fax: 818-365-4031
View Map External Link
Primary Practice Address 7138 VAN NUYS BLVD
VAN NUYS, CA 91405-3005
United States

Phone: 818-778-6240 | Fax: 818-994-8005
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 208000000X - Pediatrics CA A068411