Provider Demographics
NPI:1639311731
Name:VAHIDI, KIARASH (MD)
Entity Type:Individual
Prefix:DR
First Name:KIARASH
Middle Name:
Last Name:VAHIDI
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 1:1030 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1640
Mailing Address - Country:US
Mailing Address - Phone:415-307-7401
Mailing Address - Fax:
Practice Address - Street 1:15031 RINALDI ST
Practice Address - Street 2:
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1207
Practice Address - Country:US
Practice Address - Phone:818-898-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-03
Last Update Date:2015-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHL057EMedicare PIN
CAHL057OMedicare PIN
CAHL057SMedicare PIN
CAHL057WMedicare PIN
CAHL057XMedicare PIN
CAHL057HMedicare PIN
CAHL057KMedicare PIN
CAHL057MMedicare PIN
CAHL057YMedicare PIN
CAHL057GMedicare PIN
CAHL057TMedicare PIN
CAHL057UMedicare PIN
CAHL057PMedicare PIN
CAHL057QMedicare PIN
CAHL057RMedicare PIN
CAHL057VMedicare PIN
CAHL057ZMedicare PIN
CAHL057IMedicare PIN
CAHL057LMedicare PIN
CAHL057NMedicare PIN
CAHL057JMedicare PIN
CAHL057FMedicare PIN