Healthcare Provider Details

I. General information

NPI: 1447061833
Provider Name (Legal Business Name): ELHAM AHMADI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12141 BROOKHURST ST STE 101
GARDEN GROVE CA
92840-2865
US

IV. Provider business mailing address

12141 BROOKHURST ST STE 101
GARDEN GROVE CA
92840-2865
US

V. Phone/Fax

Practice location:
  • Phone: 714-296-1934
  • Fax:
Mailing address:
  • Phone: 714-296-1934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: