Provider Demographics
NPI:1346421633
Name:MOTAGHEDI, BIJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:BIJAN
Middle Name:
Last Name:MOTAGHEDI
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 1:501 RUE DE SANTE
Mailing Address - Street 2:SUITE11
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-5400
Mailing Address - Country:US
Mailing Address - Phone:985-652-4229
Mailing Address - Fax:985-652-4270
Practice Address - Street 1:501 RUE DE SANTE
Practice Address - Street 2:SUITE11
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068-5400
Practice Address - Country:US
Practice Address - Phone:985-652-4229
Practice Address - Fax:985-652-4270
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA04347R174400000X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309583Medicaid
LAC67604Medicare UPIN