Healthcare Provider Details

I. General information

NPI: 1730271099
Provider Name (Legal Business Name): ARBI KHODADADI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 E WALNUT ST SUITE 120
PASADENA CA
91106-1451
US

IV. Provider business mailing address

1030 TIVERTON AVE 113
LOS ANGELES CA
90024-3000
US

V. Phone/Fax

Practice location:
  • Phone: 626-304-0782
  • Fax: 626-795-8603
Mailing address:
  • Phone: 805-886-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA83304
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberA83304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: