Healthcare Provider Details

I. General information

NPI: 1659452969
Provider Name (Legal Business Name): KAYVON K. YADIDI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 01/24/2025
Certification Date: 01/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE 703
LOS ANGELES CA
90015-3068
US

IV. Provider business mailing address

10573 W PICO BLVD # 328
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 323-408-8532
  • Fax: 323-408-8534
Mailing address:
  • Phone: 109-481-8013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number20A6595
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A6595
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: