Provider Demographics
NPI:1932390853
Name:ASHTON A KAIDI, MD, INC A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ASHTON A KAIDI, MD, INC A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAIDI, M.D.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-640-8576
Mailing Address - Street 1:PO BOX 697
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-0697
Mailing Address - Country:US
Mailing Address - Phone:909-570-9108
Mailing Address - Fax:909-570-9334
Practice Address - Street 1:1441 AVOCADO AVE
Practice Address - Street 2:SUITE 601
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7721
Practice Address - Country:US
Practice Address - Phone:949-640-8576
Practice Address - Fax:949-644-8763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG802592086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF80131Medicare UPIN
CAG80259Medicare PIN