Organization Active NPI

Mehrdad Pakdaman MD Inc

  • Clinic/Center
  • Los Angeles, CA
National Provider Identifier
1396071304
Registry record updated Jan 6, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
A88797 Issued in CA
Legal business name
MEHRDAD PAKDAMAN MD INC
Practice address
1115 S Robertson Blvd
Los Angeles, CA 90035-1403
Phone
(310) 659-9999
NPI assigned
Oct 26, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mehrdad PakdamanNPI 1942352315
Title
MD
Phone
(310) 659-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X A88797 CA Primary

Addresses

Primary practice location

1115 S Robertson Blvd
Los Angeles, CA 90035-1403

Mailing address

1115 S Robertson Blvd
Los Angeles, CA 90035-1403
Phone (310) 659-9999

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110816000296 CA Part B Supplier - Clinic/Group Practice 5496924029 Receives reassigned benefits from 1 practitioner
Practice locations: Los Angeles, CA

National Provider Directory

National Provider Directory

Locations

1115 S Robertson Blvd
Los Angeles, CA 90035
Phone (310) 246-4171

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1256515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325808000000",
    "number": "1396071304",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 S ROBERTSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351403",
            "telephone_number": "310-659-9999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 S ROBERTSON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900351403",
            "telephone_number": "310-659-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHRDAD PAKDAMAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-26",
        "last_updated": "2012-01-06",
        "status": "A",
        "authorized_official_last_name": "PAKDAMAN",
        "authorized_official_first_name": "MEHRDAD",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "310-659-9999",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "CA",
            "license": "A88797",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.