Provider Demographics
NPI:1184021040
Name:HENDIZADEH, MOSHE S (MD)
Entity Type:Individual
Prefix:DR
First Name:MOSHE
Middle Name:S
Last Name:HENDIZADEH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SAMMY
Other - Middle Name:
Other - Last Name:HENDIZADEH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10966 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2115
Mailing Address - Country:US
Mailing Address - Phone:310-422-6111
Mailing Address - Fax:310-861-9926
Practice Address - Street 1:10966 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2115
Practice Address - Country:US
Practice Address - Phone:310-422-6111
Practice Address - Fax:310-861-9926
Is Sole Proprietor?:No
Enumeration Date:2014-11-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1396842084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA139684OtherSTATE LICENSE