Provider Demographics
NPI:1316038169
Name:DARDASHTI, MALIHE (MD)
Entity Type:Individual
Prefix:
First Name:MALIHE
Middle Name:
Last Name:DARDASHTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 WILSHIRE BLVD STE 625
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-3120
Mailing Address - Country:US
Mailing Address - Phone:310-360-9785
Mailing Address - Fax:
Practice Address - Street 1:8500 WILSHIRE BLVD STE 625
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3120
Practice Address - Country:US
Practice Address - Phone:310-360-9785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A410920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A410920Medicaid
CA00A410920Medicaid
CAA29293Medicare UPIN