MEDICARE: DR. KAYVON K. YADIDI D.O.

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	2083X0100X	Occupational Medicine Physician	20A6595	CA
2	207R00000X	Internal Medicine Physician	20A6595	CA

General Provider Information

NPI Number	:	1659452969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KAYVON K. YADIDI D.O.

Provider Business Mailing Address
First Line	:	10573 W PICO BLVD # 328
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2333
Country	:	US
Telephone Number	:	109-481-8013
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE STE 703
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3068
Country	:	US
Telephone Number	:	323-408-8532
Fax Number	:	323-408-8534

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/24/2025

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Directions to “ DR. KAYVON K. YADIDI D.O.” Practice Location

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