Healthcare Provider Details

I. General information

NPI: 1063116531
Provider Name (Legal Business Name): YASMIN IZZAH RADZI DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E OLIVE AVE SUITE 840
LOS ANGELES CA
91502
US

IV. Provider business mailing address

1439 ALAMEDA AVE
LAKEWOOD OH
44107-4920
US

V. Phone/Fax

Practice location:
  • Phone: 213-373-3246
  • Fax:
Mailing address:
  • Phone: 832-266-8825
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE6259
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: