Provider Demographics
NPI:1760780597
Name:YADIDI, MAHYAR DAVID (DC)
Entity Type:Individual
Prefix:
First Name:MAHYAR
Middle Name:DAVID
Last Name:YADIDI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1440 VETERAN AVE APT 604
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4883
Mailing Address - Country:US
Mailing Address - Phone:310-666-4721
Mailing Address - Fax:
Practice Address - Street 1:9160 BEVERLY BLVD APT 304
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4001
Practice Address - Country:US
Practice Address - Phone:310-859-1884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-02
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC31098111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor