Provider Demographics
NPI:1780010066
Name:YEGANEH HAJAHMADI, MAHMOUD
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:
Last Name:YEGANEH HAJAHMADI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10231 SLATER AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4745
Mailing Address - Country:US
Mailing Address - Phone:213-375-8850
Mailing Address - Fax:
Practice Address - Street 1:10231 SLATER AVE
Practice Address - Street 2:SUITE # 113
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4773
Practice Address - Country:US
Practice Address - Phone:714-968-4446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15561171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist