Healthcare Provider Details

I. General information

NPI: 1497250955
Provider Name (Legal Business Name): OMEED AHADIAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 11/05/2025
Certification Date: 11/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26700 TOWNE CENTRE DR STE 170
FOOTHILL RANCH CA
92610-2850
US

IV. Provider business mailing address

20270 KLINE LN
YORBA LINDA CA
92887-3269
US

V. Phone/Fax

Practice location:
  • Phone: 949-919-3834
  • Fax: 949-535-4411
Mailing address:
  • Phone:
  • Fax: 949-535-4411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA163538
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: