Provider Demographics
NPI:1548211436
Name:ADIBI, KAMI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAMI
Middle Name:
Last Name:ADIBI
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 1:1414 S GRAND AVE STE 380
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3072
Mailing Address - Country:US
Mailing Address - Phone:310-717-5777
Mailing Address - Fax:
Practice Address - Street 1:1414 S GRAND AVE STE 380
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3072
Practice Address - Country:US
Practice Address - Phone:310-717-5777
Practice Address - Fax:818-578-8865
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64723207QA0401X, 207Q00000X
COA64723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA64723Medicare UPIN
CAI00310Medicare UPIN