Provider Demographics
NPI:1225134232
Name:VAHDAT, ARASH (MD)
Entity Type:Individual
Prefix:DR
First Name:ARASH
Middle Name:
Last Name:VAHDAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25946
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0946
Mailing Address - Country:US
Mailing Address - Phone:818-665-2065
Mailing Address - Fax:
Practice Address - Street 1:18370 BURBANK BLVD STE 714
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2827
Practice Address - Country:US
Practice Address - Phone:818-665-2065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73458207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA73458OtherMEDICAL LICENCE
CAA73458OtherMEDICAL LICENCE