Provider Demographics
NPI:1467539122
Name:AZADEH, H (MD)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:
Last Name:AZADEH
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 1:18251 ROSCOE BLVD
Mailing Address - Street 2:#203
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325
Mailing Address - Country:US
Mailing Address - Phone:818-885-7611
Mailing Address - Fax:818-885-8236
Practice Address - Street 1:18251 ROSCOE BLVD
Practice Address - Street 2:#203
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325
Practice Address - Country:US
Practice Address - Phone:818-885-7611
Practice Address - Fax:818-885-8236
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A246810Medicaid
B49992Medicare UPIN
CA00A246810Medicaid