Provider Demographics
NPI:1659452969
Name:YADIDI, KAYVON K (DO)
Entity Type:Individual
Prefix:DR
First Name:KAYVON
Middle Name:K
Last Name:YADIDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:222 W EULALIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-246-4800
Mailing Address - Fax:818-246-4805
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-246-4800
Practice Address - Fax:818-246-4805
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2010-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6595207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00124Medicare UPIN