Healthcare Provider Details

I. General information

NPI: 1639489636
Provider Name (Legal Business Name): KAMRAN YAHODAEI MDPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2010
Last Update Date: 10/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 138TH ST
BRONX NY
10454-2702
US

IV. Provider business mailing address

601 E 138TH ST
BRONX NY
10454-2702
US

V. Phone/Fax

Practice location:
  • Phone: 718-292-2682
  • Fax:
Mailing address:
  • Phone: 718-292-2682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number229533
License Number StateNY

VIII. Authorized Official

Name: DR. KAMRAN YAHODAEI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-292-2682