Provider Demographics
NPI:1942252028
Name:AHMADI, JAMSHID (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMSHID
Middle Name:
Last Name:AHMADI
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:PO BOX 31399
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0399
Mailing Address - Country:US
Mailing Address - Phone:626-457-5842
Mailing Address - Fax:626-457-5843
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:LOWER LEVEL, SUITE 1600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-7450
Practice Address - Fax:323-442-7455
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA321512085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A321510Medicaid
CA00A321510OtherBLUE SHIELD
CA300031892OtherRAIL ROAD MEDICARE
CA00A321510G56OtherCAL-OPTIMA
CA00A321510Medicaid
CAWA32151NMedicare PIN
CAWA32151OMedicare PIN
CA00A321510G56OtherCAL-OPTIMA
CAA87610Medicare UPIN