Healthcare Provider Details

I. General information

NPI: 1285696476
Provider Name (Legal Business Name): HOOMAN MADYOON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HOOMAN MADYOON M.D.

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/29/2023
Certification Date: 11/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 S SAN VICENTE BLVD STE 350
LOS ANGELES CA
90048-4659
US

IV. Provider business mailing address

640 S SAN VICENTE BLVD STE 350
LOS ANGELES CA
90048-4659
US

V. Phone/Fax

Practice location:
  • Phone: 310-402-8858
  • Fax: 310-708-0175
Mailing address:
  • Phone: 310-402-8858
  • Fax: 310-708-0175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA48701
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA48701
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: