Provider Demographics
NPI:1235139437
Name:IZADI, MEHDI (DO)
Entity Type:Individual
Prefix:DR
First Name:MEHDI
Middle Name:
Last Name:IZADI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 MEDICAL CENTER DR. SUITE 302
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307
Mailing Address - Country:US
Mailing Address - Phone:818-888-3387
Mailing Address - Fax:818-888-3391
Practice Address - Street 1:7301 MEDICAL CENTER DR. SUITE 302
Practice Address - Street 2:
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307
Practice Address - Country:US
Practice Address - Phone:818-888-3387
Practice Address - Fax:818-888-3391
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE49730207Q00000X
CA20A5509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX55090Medicaid
CA00AX55090Medicaid
CACE7126Medicare PIN
CA020A55090Medicare PIN