=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427248368
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YAGHOUB BADYMOGHADDAM MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2007
-----------------------------------------------------
Last Update Date | 07/26/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5726 E OLYMPIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-5120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-727-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5726 E OLYMPIC BLVD
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90022-5120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 323-727-7000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. YAGHOUB BADYMOGHADDAM
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 323-727-7000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208D00000X
-----------------------------------------------------
Taxonomy Name | General Practice Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------