MEDICARE: DR. DAN E DARDASHTI M.D.

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	207R00000X	Internal Medicine Physician	A61457	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275537524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAN E DARDASHTI M.D.

Provider Business Mailing Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	STE 506
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	818-508-9190
Fax Number	:	818-508-1648

Provider Business Practice Location Address
First Line	:	12626 RIVERSIDE DR
Second Line	:	STE 506
City	:	VALLEY VILLAGE
State	:	CA
Zip	:	91607-3420
Country	:	US
Telephone Number	:	818-508-9190
Fax Number	:	818-508-1648

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/02/2010

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