Provider Demographics
NPI:1568456911
Name:MAHDAVIE, KARIM NOURI (MD)
Entity Type:Individual
Prefix:
First Name:KARIM
Middle Name:NOURI
Last Name:MAHDAVIE
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 1:4775 DEL MORENO PL
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4634
Mailing Address - Country:US
Mailing Address - Phone:818-346-4380
Mailing Address - Fax:
Practice Address - Street 1:2755 ALAMO ST
Practice Address - Street 2:STE 100
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1311
Practice Address - Country:US
Practice Address - Phone:805-210-7280
Practice Address - Fax:805-210-7281
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50379207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10984Medicare UPIN