Provider Demographics
NPI:1912093436
Name:AHMADPOUR, HED (MD)
Entity type:Individual
Prefix:DR
First Name:HED
Middle Name:
Last Name:AHMADPOUR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:HEDAYATOLAH
Other - Middle Name:
Other - Last Name:AHMADPOUR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:25050 AVENUE KEARNY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1255
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:3650 SOUTH ST
Practice Address - Street 2:SUITE 110B
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-1502
Practice Address - Country:US
Practice Address - Phone:562-925-8407
Practice Address - Fax:562-925-1723
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30282207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA30282OtherCALIF MEDICAL LICENSE #
CA00A302820Medicaid
CAWA30282KMedicare PIN
CA00A302820Medicaid