Provider Demographics
NPI:1689618910
Name:SAHEBEKHTIARI, HEIDARALI (MD)
Entity Type:Individual
Prefix:
First Name:HEIDARALI
Middle Name:
Last Name:SAHEBEKHTIARI
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 1:700 PALISADE ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2060
Mailing Address - Country:US
Mailing Address - Phone:626-252-4130
Mailing Address - Fax:626-628-1732
Practice Address - Street 1:700 PALISADE ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-2060
Practice Address - Country:US
Practice Address - Phone:626-252-4130
Practice Address - Fax:626-628-1732
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A331620Medicaid
CAA33162Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAA27059Medicare UPIN