Provider Demographics
NPI:1780055269
Name:BEHROUZ DARDASHTI M.D A MEDICAL CORPORATION
Entity type:Organization
Organization Name:BEHROUZ DARDASHTI M.D A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BEHROUZ
Authorized Official - Middle Name:
Authorized Official - Last Name:DARDASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-995-6003
Mailing Address - Street 1:16250 VENTURA BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2204
Mailing Address - Country:US
Mailing Address - Phone:818-995-6003
Mailing Address - Fax:818-995-3862
Practice Address - Street 1:16250 VENTURA BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2204
Practice Address - Country:US
Practice Address - Phone:818-995-6003
Practice Address - Fax:818-995-3862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-09
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38320208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty