Provider Demographics
NPI:1376613455
Name:YADEGAR, SASAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SASAN
Middle Name:
Last Name:YADEGAR
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:P.O. BOX 241080
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024
Mailing Address - Country:US
Mailing Address - Phone:310-673-7724
Mailing Address - Fax:310-673-5895
Practice Address - Street 1:501 EAST HARDY STREET
Practice Address - Street 2:SUITE 407
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301
Practice Address - Country:US
Practice Address - Phone:310-673-7724
Practice Address - Fax:310-673-5895
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG72739207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG72739Medicare UPIN