Provider Demographics
NPI:1962680348
Name:MEHDIKHANI, EDGAR (MD)
Entity Type:Individual
Prefix:
First Name:EDGAR
Middle Name:
Last Name:MEHDIKHANI
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 1:222 W EULALIA ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2849
Mailing Address - Country:US
Mailing Address - Phone:818-242-8916
Mailing Address - Fax:818-241-7708
Practice Address - Street 1:222 W EULALIA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2849
Practice Address - Country:US
Practice Address - Phone:818-242-8916
Practice Address - Fax:818-241-7708
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA96024207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology