Provider Demographics
NPI:1629458765
Name:AIDA K RECHDOUNI, MD INC
Entity Type:Organization
Organization Name:AIDA K RECHDOUNI, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:KAROUN
Authorized Official - Last Name:RECHDOUNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-468-2929
Mailing Address - Street 1:2750 PINERIDGE PL
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1458
Mailing Address - Country:US
Mailing Address - Phone:818-468-2929
Mailing Address - Fax:888-610-8908
Practice Address - Street 1:2626 FOOTHILL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-3574
Practice Address - Country:US
Practice Address - Phone:888-610-8909
Practice Address - Fax:888-610-8908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72786207ZP0102X
CACLF00342461291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Single Specialty