Healthcare Provider Details

I. General information

NPI: 1881744480
Provider Name (Legal Business Name): ANGELOS ARISTEIDIS KONSTAS MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

223 N 1ST AVE STE 101
ARCADIA CA
91006-7027
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-5139
  • Fax: 626-447-1058
Mailing address:
  • Phone: 626-698-7246
  • Fax: 626-698-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number277245
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA114761
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number277245
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA114761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: