Provider Demographics
NPI:1295095669
Name:MAHDAVI, PAYMOHN (MD)
Entity type:Individual
Prefix:DR
First Name:PAYMOHN
Middle Name:
Last Name:MAHDAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:1845 W REDLANDS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-3125
Practice Address - Country:US
Practice Address - Phone:909-363-1450
Practice Address - Fax:909-363-1480
Is Sole Proprietor?:No
Enumeration Date:2012-05-20
Last Update Date:2023-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA162708207W00000X, 207WX0107X
MDD0083614207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology