| Dan Dardashti, Md Inc. | |
|
12626 Riverside Dr Suite #506 Valley Village CA 91607-3420 | |
| (818) 508-9190 | |
| (818) 508-1648 |
| Full Name | Dan Dardashti, Md Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 12626 Riverside Dr, Valley Village, California |
| Authorized Official Name and Position | Dan Elia Dardashti (PRESIDENT) |
| Authorized Official Contact | 8185089190 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dan Dardashti, Md Inc. 12626 Riverside Dr Suite #506 Valley Village CA 91607-3420 Ph: (818) 508-9190 | Dan Dardashti, Md Inc. 12626 Riverside Dr Suite #506 Valley Village CA 91607-3420 Ph: (818) 508-9190 |
| NPI Number | 1114953643 |
|---|---|
| Provider Enumeration Date | 06/25/2006 |
| Last Update Date | 07/02/2010 |
| Medicare PECOS PAC ID | 6204841232 |
|---|---|
| Medicare Enrollment ID | O20060213000701 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114953643 | NPI | - | NPPES |
| 00A614570 | Other | CA | BLUESHIELD |
| 00A614570 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A61457 (California) | Primary |
| Provider Name | Dan E Dardashti |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275537524 PECOS PAC ID: 7214945872 Enrollment ID: I20060327000360 |
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