Provider Demographics
NPI:1063789774
Name:EDGAR MEHDIKHANI MD INC.
Entity type:Organization
Organization Name:EDGAR MEHDIKHANI MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHDIKHANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-927-8905
Mailing Address - Street 1:222 W EULALIA ST STE 114
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2851
Mailing Address - Country:US
Mailing Address - Phone:818-242-8916
Mailing Address - Fax:818-241-7708
Practice Address - Street 1:222 W EULALIA ST STE 114
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2851
Practice Address - Country:US
Practice Address - Phone:818-242-8916
Practice Address - Fax:818-241-7708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96024207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty