Basic Information
| Provider Information | |||||||||
| NPI: | 1730271099 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHODADADI | ||||||||
| FirstName: | ARBI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1030 TIVERTON AVE | ||||||||
| Address2: | 113 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900243000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058864339 | ||||||||
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| Practice Location | |||||||||
| Address1: | 959 E WALNUT ST | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911061451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263040782 | ||||||||
| FaxNumber: | 6267958603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2006 | ||||||||
| LastUpdateDate: | 04/19/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A83304 | CA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | A83304 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
No ID Information.