Individual
MARK GANJIANPOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6330 SAN VICENTE BLVD, SUITE 310, LOS ANGELES, CA 90048-5425
(310) 855-0751
(310) 358-2453
Mailing address
6330 SAN VICENTE BLVD, SUITE 310, LOS ANGELES, CA 90048-5425
(310) 855-0751
(310) 358-2453
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
A71208
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A712080
—
CA
01
—
346434300
DEPT OF LABOR
CA
01
—
P00068539
RAILROAD MEDICARE
CA
Enumeration date
03/14/2006
Last updated
01/29/2014
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