Basic Information
| Provider Information | |||||||||
| NPI: | 1144313768 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HED AHMADPOUR MD FACC, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25050 AVENUE KEARNY | ||||||||
| Address2: | SUITE 208 | ||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913551255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6614300940 | ||||||||
| FaxNumber: | 6612950862 | ||||||||
| Practice Location | |||||||||
| Address1: | 3650 E SOUTH STREET | ||||||||
| Address2: | SUITE 110B | ||||||||
| City: | LAKEWOOD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907121502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629258407 | ||||||||
| FaxNumber: | 5629251723 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2006 | ||||||||
| LastUpdateDate: | 04/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | AHMADPOUR | ||||||||
| AuthorizedOfficialFirstName: | HED | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5629258407 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | A30282 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | A30282 | 01 | CA | PRES. MEDICAL LICENSE# | OTHER |