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General NPI Number Information
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NPI Number | 1861410029
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Entity Type | Individual
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Provider Name | AMIR H HEDAYATI-RAD M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 706 W BROADWAY # 100
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City | GLENDALE
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State | CA
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Zip | 91204-1032
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Country | US
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Telephone | 818-507-6404
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Fax | 818-507-6406
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Provider Business Mailing Address
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Address Line | 706 W BROADWAY # 100
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City | GLENDALE
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State | CA
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Zip | 91204-1032
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Country | US
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Telephone | 818-507-6404
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Fax | 818-507-6406
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | A60239
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | A60239
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | A60239
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License Number State | CA
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