MEDICARE: DR. ARDESHIR EDWARD NADIMI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0101X	MOHS-Micrographic Surgery Physician	A168788	CA

General Provider Information

NPI Number	:	1992190417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARDESHIR EDWARD NADIMI M.D.

Provider Business Mailing Address
First Line	:	13700 MARINA POINTE DR UNIT 721
Second Line	:
City	:	MARINA DEL REY
State	:	CA
Zip	:	90292-9261
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12555 W JEFFERSON BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-7047
Country	:	US
Telephone Number	:	424-541-1756
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2015
Last Update Date	:	12/20/2025

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