Healthcare Provider Details

I. General information

NPI: 1396828455
Provider Name (Legal Business Name): MAKAN EMADI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 10/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

IV. Provider business mailing address

330 E LIVE OAK AVE
ARCADIA CA
91006-5617
US

V. Phone/Fax

Practice location:
  • Phone: 626-821-5858
  • Fax: 626-821-0858
Mailing address:
  • Phone: 626-471-6500
  • Fax: 626-471-3575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 21339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: