Healthcare Provider Details

I. General information

NPI: 1477275204
Provider Name (Legal Business Name): DAFNA AHDOOT MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/24/2022
Certification Date: 09/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22444 CRISWELL ST
WEST HILLS CA
91307-3703
US

IV. Provider business mailing address

22444 CRISWELL ST
WEST HILLS CA
91307-3703
US

V. Phone/Fax

Practice location:
  • Phone: 310-871-5337
  • Fax: 855-373-2363
Mailing address:
  • Phone: 310-871-5337
  • Fax: 855-373-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAFNA AHDOOT
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 310-871-5337