Provider Demographics
NPI:1699814533
Name:RECHDOUNI, AIDA KAROUN (MD)
Entity Type:Individual
Prefix:DR
First Name:AIDA
Middle Name:KAROUN
Last Name:RECHDOUNI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2501 WHITTIER DRIVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214
Mailing Address - Country:US
Mailing Address - Phone:818-248-9892
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE., NOR 2424
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089
Practice Address - Country:US
Practice Address - Phone:323-865-3270
Practice Address - Fax:323-865-0077
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72786174400000X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ310292ZOtherBLUE SHIELD
CAA72786OtherSTATE MEDICAL LICENSE
CA00A727860Medicaid
CAP00344958OtherRAILROAD MEDICARE
CA1952325565OtherGROUP NPI
CAP00344958OtherRAILROAD MEDICARE
CAWA72786BMedicare PIN
CAA72786OtherSTATE MEDICAL LICENSE
CA00A727860Medicaid
CAWA72786CMedicare PIN