Provider Demographics
NPI:1922502798
Name:ALIREZA EMDADI, MD., INC
Entity Type:Organization
Organization Name:ALIREZA EMDADI, MD., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALIREZA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMDADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-497-5956
Mailing Address - Street 1:17 COASTAL OAK
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-1655
Mailing Address - Country:US
Mailing Address - Phone:310-497-5956
Mailing Address - Fax:
Practice Address - Street 1:17 COASTAL OAK
Practice Address - Street 2:
Practice Address - City:NEWPORT COAST
Practice Address - State:CA
Practice Address - Zip Code:92657-1655
Practice Address - Country:US
Practice Address - Phone:310-497-5956
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty