Provider Demographics
NPI:1467407064
Name:YADEGAR, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
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 1:9301 WILSHIRE BLVD
Mailing Address - Street 2:#414
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5424
Mailing Address - Country:US
Mailing Address - Phone:310-858-8646
Mailing Address - Fax:310-858-2622
Practice Address - Street 1:9301 WILSHIRE BLVD
Practice Address - Street 2:STE 414
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-6144
Practice Address - Country:US
Practice Address - Phone:310-858-8646
Practice Address - Fax:310-858-2622
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33119208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A27039Medicare UPIN
CAA33119Medicare ID - Type Unspecified