MEDICARE: MR. JAMSHID DODI

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

General Provider Information

NPI Number	:	1932428810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMSHID DODI

Provider Business Mailing Address
First Line	:	12766 PACIFIC AVE
Second Line	:	#6
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4236
Country	:	US
Telephone Number	:	310-922-0128
Fax Number	:	310-636-1343

Provider Business Practice Location Address
First Line	:	12766 PACIFIC AVE
Second Line	:	#6
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4236
Country	:	US
Telephone Number	:	310-922-0128
Fax Number	:	310-636-1343

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

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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