Provider Demographics
NPI:1275552705
Name:DARDASHTI, BEHROUZ B (MD)
Entity Type:Individual
Prefix:DR
First Name:BEHROUZ
Middle Name:B
Last Name:DARDASHTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7301 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1904
Mailing Address - Country:US
Mailing Address - Phone:818-888-3903
Mailing Address - Fax:818-888-1035
Practice Address - Street 1:7301 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1904
Practice Address - Country:US
Practice Address - Phone:818-888-3903
Practice Address - Fax:818-888-1035
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA35233207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50372Medicare UPIN