Provider Demographics
NPI:1427248368
Name:YAGHOUB BADYMOGHADDAM MD INC
Entity type:Organization
Organization Name:YAGHOUB BADYMOGHADDAM MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YAGHOUB
Authorized Official - Middle Name:
Authorized Official - Last Name:BADYMOGHADDAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-727-7000
Mailing Address - Street 1:5726 E OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-5120
Mailing Address - Country:US
Mailing Address - Phone:323-727-7000
Mailing Address - Fax:
Practice Address - Street 1:5726 E OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-5120
Practice Address - Country:US
Practice Address - Phone:323-727-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11111OtherWAITING FOR MEDI-CAL NUMB