Provider Demographics
NPI:1306916390
Name:KADDIS, HODA (MD)
Entity type:Individual
Prefix:
First Name:HODA
Middle Name:
Last Name:KADDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 39667
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90239-0667
Mailing Address - Country:US
Mailing Address - Phone:714-347-0477
Mailing Address - Fax:714-347-0499
Practice Address - Street 1:200 W SANTA ANA BLVD
Practice Address - Street 2:SUITE # 100
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-4134
Practice Address - Country:US
Practice Address - Phone:714-347-0477
Practice Address - Fax:714-347-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46408208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics