Provider Demographics
NPI:1083757132
Name:AHDOOT, ROBEN DAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBEN
Middle Name:DAN
Last Name:AHDOOT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2948
Mailing Address - Fax:916-858-7065
Practice Address - Street 1:3000 Q ST FL 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-7058
Practice Address - Country:US
Practice Address - Phone:916-733-3301
Practice Address - Fax:916-281-3882
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2020-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA623952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA62395OtherMEDICAL LICENSE