Healthcare Provider Details

I. General information

NPI: 1568456911
Provider Name (Legal Business Name): KARIM NOURI MAHDAVIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 09/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 ALAMO ST STE 100
SIMI VALLEY CA
93065-1311
US

IV. Provider business mailing address

4775 DEL MORENO PL
WOODLAND HILLS CA
91364-4634
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-7280
  • Fax: 805-210-7281
Mailing address:
  • Phone: 818-346-4380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberC50379
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC50379
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: