Provider Demographics
NPI:1336179563
Name:MIRHADI, AMIN (MD)
Entity Type:Individual
Prefix:
First Name:AMIN
Middle Name:
Last Name:MIRHADI
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 1:8700 BEVERLY BLVD
Mailing Address - Street 2:SUITE AC-1020
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1804
Mailing Address - Country:US
Mailing Address - Phone:310-423-5212
Mailing Address - Fax:310-659-3332
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:RM AC-1020
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-4206
Practice Address - Fax:310-659-3332
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA808902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A808900Medicaid
CA00A808900Medicaid
I55324Medicare UPIN