MEDICARE: MEHDI JAMEHDOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207SC0300X	Clinical Cytogenetics Physician	C42014	CA

General Provider Information

NPI Number	:	1205995891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHDI JAMEHDOR MD

Provider Business Mailing Address
First Line	:	4760 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6063
Country	:	US
Telephone Number	:	323-783-4011
Fax Number	:

Provider Business Practice Location Address
First Line	:	4760 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6063
Country	:	US
Telephone Number	:	323-783-4011
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2006
Last Update Date	:	09/23/2008

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