Provider Demographics
NPI:1841272697
Name:AHDOOT, JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:AHDOOT
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 1:50 BELLEFONTAINE ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-796-9259
Mailing Address - Fax:626-449-8560
Practice Address - Street 1:50 BELLEFONTAINE ST
Practice Address - Street 2:SUITE 405
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-796-9259
Practice Address - Fax:626-449-8560
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55697207RC0000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18762OtherGROUP MEDICARE
CAGR0100430OtherGROUP MEDICAL
CA1902846306OtherGROUP NPI
CAOOA556970Medicaid
CAGR0100430OtherGROUP MEDICAL