Provider Demographics
NPI:1003132523
Name:MASHHADIAN, ARDAVAN (DO)
Entity Type:Individual
Prefix:DR
First Name:ARDAVAN
Middle Name:
Last Name:MASHHADIAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S GRAND AVE STE 615
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3069
Mailing Address - Country:US
Mailing Address - Phone:213-537-0328
Mailing Address - Fax:213-210-2400
Practice Address - Street 1:1400 S GRAND AVE STE 615
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3069
Practice Address - Country:US
Practice Address - Phone:213-537-0328
Practice Address - Fax:213-210-2400
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11899207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology