Provider Demographics
NPI:1356571897
Name:AHDOUT, JENNIFER (MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:AHDOUT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 N ROXBURY DR
Mailing Address - Street 2:STE 400
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4218
Mailing Address - Country:US
Mailing Address - Phone:424-394-1610
Mailing Address - Fax:424-394-1628
Practice Address - Street 1:450 N ROXBURY DR
Practice Address - Street 2:STE 400
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4218
Practice Address - Country:US
Practice Address - Phone:424-394-1610
Practice Address - Fax:424-394-1628
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA115046207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology