Provider Demographics
NPI:1245242767
Name:KAIDI, ASHTON A (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:A
Last Name:KAIDI
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 697
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-0697
Mailing Address - Country:US
Mailing Address - Phone:909-570-9108
Mailing Address - Fax:909-570-9334
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-640-8576
Practice Address - Fax:949-644-8763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG802592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG80259Medicare PIN
CAF80131Medicare UPIN