Provider Demographics
NPI:1447565908
Name:IRAJ DARDASHTI MD INC
Entity Type:Organization
Organization Name:IRAJ DARDASHTI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRAJ
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-552-9200
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:STE 1010
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-552-9200
Mailing Address - Fax:310-552-2848
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:STE 1010
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-552-9200
Practice Address - Fax:310-552-2848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33371207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84463Medicare UPIN