Provider Demographics
NPI:1487888707
Name:BENDAVID, OMID (MD)
Entity type:Individual
Prefix:
First Name:OMID
Middle Name:
Last Name:BENDAVID
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 N LA CIENEGA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2286
Mailing Address - Country:US
Mailing Address - Phone:310-927-0002
Mailing Address - Fax:
Practice Address - Street 1:99 N LA CIENEGA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2286
Practice Address - Country:US
Practice Address - Phone:310-927-0002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA940552085B0100X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A940550Medicaid
CABW186ZMedicare PIN