Provider Demographics
NPI:1205000890
Name:AKHONDI, ANDRE BABAK
Entity Type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:BABAK
Last Name:AKHONDI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:ANDRE
Other - Middle Name:
Other - Last Name:AKHONDI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 MOODY CT STE 110
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6076
Practice Address - Country:US
Practice Address - Phone:805-418-3500
Practice Address - Fax:805-418-3505
Is Sole Proprietor?:No
Enumeration Date:2008-04-15
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111933207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty