Provider Demographics
NPI:1720183924
Name:ZADEH, MANI (MD)
Entity Type:Individual
Prefix:DR
First Name:MANI
Middle Name:
Last Name:ZADEH
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 1:2080 CENTURY PARK E STE 1701
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2020
Mailing Address - Country:US
Mailing Address - Phone:310-286-0123
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1701
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2020
Practice Address - Country:US
Practice Address - Phone:310-286-0123
Practice Address - Fax:310-201-0991
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80819207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA80819AMedicare ID - Type UnspecifiedMEDICARE
CAH85353Medicare UPIN