Healthcare Provider Details

I. General information

NPI: 1346351798
Provider Name (Legal Business Name): AHMAD SADEGHI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

143 ALTA AVE
SANTA MONICA CA
90402-2725
US

V. Phone/Fax

Practice location:
  • Phone: 310-478-3711
  • Fax: 310-268-2549
Mailing address:
  • Phone: 310-395-3117
  • Fax: 310-395-5446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA38852
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberA38852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: