MEDICARE: MEHRDAD PAKDAMAN MD

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	207Q00000X	Family Medicine Physician	A88797	CA

General Provider Information

NPI Number	:	1942352315
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEHRDAD PAKDAMAN MD

Provider Business Mailing Address
First Line	:	2170 LINNINGTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-5935
Country	:	US
Telephone Number	:	310-659-9999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1403
Country	:	US
Telephone Number	:	310-659-9999
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	06/13/2011

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