Provider Demographics
NPI:1326080060
Name:KADES, WAGDY WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:WAGDY
Middle Name:WILLIAM
Last Name:KADES
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 1:1245 WILSHIRE BLVD STE 775
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4881
Mailing Address - Country:US
Mailing Address - Phone:213-484-5397
Mailing Address - Fax:213-484-9584
Practice Address - Street 1:1245 WILSHIRE BLVD STE 775
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4881
Practice Address - Country:US
Practice Address - Phone:213-484-5397
Practice Address - Fax:213-484-9584
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA56293207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12062138OtherM ULTI-PLAN
CA2224551OtherCCN PROVIDER NUMBER
CA00A562930OtherBLUE SHIELD
CA731689515OtherPPO NEXT
CA5033747OtherAETNA PROVIDER NUMBER
CA8005463887OtherUNITED HEALTH CARE (NEW )
CA00073212OtherMEDICARE RAILROAD
CA00A562930Medicaid
CA731689515OtherBLUE CROSS NUMBER
CA731689515OtherCHOICE CARE PROVIDER
CA731689515OtherCHOICE CARE
CA731689515OtherBEECH STREET PROVIDER
CA11003054OtherCAOH PROVIDER NUMBER
CA5444347OtherCCN PROVIDER NUMBER
CA731689515OtherPHCS PROVIDER NUMBER