Provider Demographics
NPI:1003218231
Name:BEHROUZ DARDASHTI, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BEHROUZ DARDASHTI, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHROUZ
Authorized Official - Middle Name:B
Authorized Official - Last Name:DARDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-888-3903
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:310-943-4180
Mailing Address - Fax:888-431-8819
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 305
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-888-3903
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEHROUZ DARDASHTI, M.D., A MEDICAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35233332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site