Healthcare Provider Details

I. General information

NPI: 1225134232
Provider Name (Legal Business Name): ARASH VAHDAT M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18370 BURBANK BLVD STE 714
TARZANA CA
91356-2827
US

IV. Provider business mailing address

PO BOX 25946
LOS ANGELES CA
90025-0946
US

V. Phone/Fax

Practice location:
  • Phone: 818-665-2065
  • Fax:
Mailing address:
  • Phone: 818-665-2065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA73458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: