Healthcare Provider Details

I. General information

NPI: 1992190417
Provider Name (Legal Business Name): ARDESHIR EDWARD NADIMI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12555 W JEFFERSON BLVD STE 202
LOS ANGELES CA
90066-7047
US

IV. Provider business mailing address

13700 MARINA POINTE DR UNIT 721
MARINA DEL REY CA
90292-9261
US

V. Phone/Fax

Practice location:
  • Phone: 424-541-1756
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA168788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: