Provider Demographics
NPI:1649404534
Name:MEHDI HABIBI, MD, INC.
Entity Type:Organization
Organization Name:MEHDI HABIBI, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIBI
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:323-665-4690
Mailing Address - Street 1:1300 NORTH VERMONT AVE
Mailing Address - Street 2:SUITE 504
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6005
Mailing Address - Country:US
Mailing Address - Phone:323-665-4690
Mailing Address - Fax:323-665-8637
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 504
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:323-665-4690
Practice Address - Fax:323-665-8637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39878207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1083759997Medicaid
CAA39878Medicare PIN