Provider Demographics
NPI:1346351798
Name:SADEGHI, AHMAD (MD)
Entity Type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:SADEGHI
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 1:143 ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2725
Mailing Address - Country:US
Mailing Address - Phone:310-395-3117
Mailing Address - Fax:310-395-5446
Practice Address - Street 1:11301 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073-1003
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:310-268-2549
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA388522085R0001X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Not Answered2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology