MEDICARE: DR. HMA MAHDAVI 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	2080P0210X	Pediatric Nephrology Physician	A72759	CA

General Provider Information

NPI Number	:	1780773721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HMA MAHDAVI M.D.

Provider Business Mailing Address
First Line	:	6101 BALL RD STE 310
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-3966
Country	:	US
Telephone Number	:	714-220-9486
Fax Number	:	714-220-9481

Provider Business Practice Location Address
First Line	:	1760 TERMINO AVE STE 214
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-2169
Country	:	US
Telephone Number	:	562-933-6933
Fax Number	:	562-933-6939

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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