Provider Demographics
NPI:1013338730
Name:MEHDIZADEH, ARDAVAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDAVAN
Middle Name:
Last Name:MEHDIZADEH
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 1:12900 PARK PLAZA DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-9329
Mailing Address - Country:US
Mailing Address - Phone:562-207-0139
Mailing Address - Fax:562-741-4479
Practice Address - Street 1:12900 PARK PLAZA DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-9329
Practice Address - Country:US
Practice Address - Phone:562-207-0139
Practice Address - Fax:562-741-4479
Is Sole Proprietor?:No
Enumeration Date:2013-12-23
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA128198207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine