Provider Demographics
NPI:1568559102
Name:AHDOOT, JONATHAN J (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:J
Last Name:AHDOOT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAHANGIR
Other - Middle Name:J
Other - Last Name:AHDOUT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:15775 LAGUNA CANYON RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3145
Mailing Address - Country:US
Mailing Address - Phone:949-727-4330
Mailing Address - Fax:
Practice Address - Street 1:15775 LAGUNA CANYON RD
Practice Address - Street 2:SUITE 290
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3145
Practice Address - Country:US
Practice Address - Phone:949-727-4330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44025207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease