Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | A100335 | CA |
N | 111NI0900X | Internist | A100335 | CA |
Y | 207RG0100X | Gastroenterologist | A100335 | CA |
N | 208D00000X | General Practice Physician | A100335 | CA |
NPI | 1023293016 |
---|---|
Provider Name | Dr. Michael Yadegari |
First Address | Los Angeles, CA 90007-3817 |
Second Address | Van Nuys, CA 91411-1114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2008 |
Last Update Date | 02/02/2018 |