Provider Demographics
NPI:1982982401
Name:HAMID MORADI MD INC
Entity Type:Organization
Organization Name:HAMID MORADI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-881-8210
Mailing Address - Street 1:19231 VICTORY BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-6343
Mailing Address - Country:US
Mailing Address - Phone:818-881-8210
Mailing Address - Fax:818-881-1710
Practice Address - Street 1:19231 VICTORY BLVD STE 210
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6343
Practice Address - Country:US
Practice Address - Phone:818-881-8210
Practice Address - Fax:818-881-1710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66448208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty