Provider Demographics
NPI:1720110349
Name:JAMSHID MADDAHI, MD, INC.
Entity Type:Organization
Organization Name:JAMSHID MADDAHI, MD, INC.
Other - Org Name:LOS ANGELES CARDIOVASCULAR MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADDAHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-824-4991
Mailing Address - Street 1:100 UCLA MEDICAL PLZ # 410
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-7064
Mailing Address - Country:US
Mailing Address - Phone:310-824-4991
Mailing Address - Fax:310-824-7082
Practice Address - Street 1:11859 WILSHIRE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6600
Practice Address - Country:US
Practice Address - Phone:310-824-4991
Practice Address - Fax:310-824-7082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA031808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW17360Medicare PIN
CAA84267Medicare UPIN