Provider Demographics
NPI:1497849418
Name:MIREMADI, ARJANG K (MD)
Entity Type:Individual
Prefix:DR
First Name:ARJANG
Middle Name:K
Last Name:MIREMADI
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 1:7702 IVANHOE AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4520
Mailing Address - Country:US
Mailing Address - Phone:858-456-1840
Mailing Address - Fax:858-456-9341
Practice Address - Street 1:7702 IVANHOE AVE
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4520
Practice Address - Country:US
Practice Address - Phone:858-456-1840
Practice Address - Fax:858-456-9341
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31016207N00000X, 207ND0900X, 207NI0002X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A310160Medicaid
CAA31016Medicare ID - Type Unspecified
A99764Medicare UPIN