MEDICARE: ARIEL MORADZADEH 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	390200000X	Student in an Organized Health Care Education/Training Program	A148329	CA
2	208800000X	Urology Physician	A148329	CA

General Provider Information

NPI Number	:	1689107922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIEL MORADZADEH M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD STE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 N LA CIENEGA BLVD STE M102
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-2288
Country	:	US
Telephone Number	:	310-385-2992
Fax Number	:	310-385-2973

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

Provider Enumeration Date	:	04/04/2017
Last Update Date	:	07/23/2021

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