Basic Information
| Provider Information | |||||||||
| NPI: | 1184624785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SADEGHI | ||||||||
| FirstName: | HAMID | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2160 | ||||||||
| Address2: | |||||||||
| City: | MOORPARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930202160 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187182301 | ||||||||
| FaxNumber: | 8187182311 | ||||||||
| Practice Location | |||||||||
| Address1: | 14860 ROSCOE BLVD | ||||||||
| Address2: | SUITE 303 | ||||||||
| City: | PANORAMA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914024665 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189019906 | ||||||||
| FaxNumber: | 8189019849 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2005 | ||||||||
| LastUpdateDate: | 11/30/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A79562 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A795620 | 05 | CA | MEDICAID |