Provider Demographics
NPI:1427849561
Name:KODADAD, RAHAM
Entity type:Individual
Prefix:
First Name:RAHAM
Middle Name:
Last Name:KODADAD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 GAUGUIN CIR
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3802
Mailing Address - Country:US
Mailing Address - Phone:858-753-5325
Mailing Address - Fax:
Practice Address - Street 1:8 TRI CITY RD
Practice Address - Street 2:
Practice Address - City:SOMMERSWORTH
Practice Address - State:NH
Practice Address - Zip Code:03878
Practice Address - Country:US
Practice Address - Phone:603-605-3185
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program