Provider Demographics
NPI:1801377890
Name:HEDAYAT, MILAD SEAN (DPM)
Entity type:Individual
Prefix:DR
First Name:MILAD
Middle Name:SEAN
Last Name:HEDAYAT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9 LANDMARK PL
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-3329
Mailing Address - Country:US
Mailing Address - Phone:949-292-5804
Mailing Address - Fax:
Practice Address - Street 1:4955 VAN NUYS BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1806
Practice Address - Country:US
Practice Address - Phone:818-995-8228
Practice Address - Fax:818-995-1539
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5489213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty