Provider Demographics
NPI:1316679558
Name:OMEED AHADIAT, M.D.
Entity type:Organization
Organization Name:OMEED AHADIAT, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OMEED
Authorized Official - Middle Name:
Authorized Official - Last Name:AHADIAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-598-9939
Mailing Address - Street 1:20270 KLINE LN
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92887-3269
Mailing Address - Country:US
Mailing Address - Phone:714-598-9939
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3167
Practice Address - Country:US
Practice Address - Phone:949-551-1113
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-27
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty