Provider Demographics
NPI:1356554802
Name:ABDIAN, LOGHMAN (MD)
Entity type:Individual
Prefix:
First Name:LOGHMAN
Middle Name:
Last Name:ABDIAN
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 1:1107 S ALVARADO ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-4161
Mailing Address - Country:US
Mailing Address - Phone:213-380-9999
Mailing Address - Fax:213-380-7904
Practice Address - Street 1:1107 S ALVARADO ST STE 102
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-4161
Practice Address - Country:US
Practice Address - Phone:213-380-9999
Practice Address - Fax:213-380-7904
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A461280Medicaid
CAWA46128AMedicare PIN