Provider Demographics
NPI:1942592811
Name:YADIDI, SIDNEY (DC)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:
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 1:2116 WILSHIRE BLVD STE 245
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5749
Mailing Address - Country:US
Mailing Address - Phone:424-235-8787
Mailing Address - Fax:
Practice Address - Street 1:2116 WILSHIRE BLVD STE 245
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-5749
Practice Address - Country:US
Practice Address - Phone:424-235-8787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31883111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor