Provider Demographics
NPI:1093960387
Name:AHMADPOUR & PEDARSANI
Entity Type:Organization
Organization Name:AHMADPOUR & PEDARSANI
Other - Org Name:HED AHMADPOUR MD INC & HOSSEIN PEDARSANI MD INC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-925-8407
Mailing Address - Street 1:PO BOX 801463
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91380-1463
Mailing Address - Country:US
Mailing Address - Phone:661-295-0859
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:3650 E SOUTH STREET
Practice Address - Street 2:SUITE 110B
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-925-8407
Practice Address - Fax:562-925-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30282207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA25686OtherPARTNER'S MEDICAL LICENSE
CAA30282OtherPARTNER'S LICENSE