Provider Demographics
NPI:1285696476
Name:MADYOON, HOOMAN (MD)
Entity type:Individual
Prefix:
First Name:HOOMAN
Middle Name:
Last Name:MADYOON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HOOMAN
Other - Middle Name:
Other - Last Name:MADYOON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:640 S SAN VICENTE BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4659
Mailing Address - Country:US
Mailing Address - Phone:310-402-8858
Mailing Address - Fax:310-708-0175
Practice Address - Street 1:640 S SAN VICENTE BLVD STE 350
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4659
Practice Address - Country:US
Practice Address - Phone:310-402-8858
Practice Address - Fax:310-708-0175
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48701207RC0000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A487011Medicaid
CAE49666Medicare UPIN
CAA48701Medicare PIN