Provider Demographics
NPI:1841622461
Name:YADIDI, BITA S (LAC)
Entity type:Individual
Prefix:
First Name:BITA
Middle Name:S
Last Name:YADIDI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:324 S BEVERLY DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4801
Mailing Address - Country:US
Mailing Address - Phone:310-863-4495
Mailing Address - Fax:310-275-3014
Practice Address - Street 1:11704 WILSHIRE BLVD
Practice Address - Street 2:SUITE 293
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1507
Practice Address - Country:US
Practice Address - Phone:310-919-4213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA15460171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist