Provider Demographics
NPI:1538208111
Name:UNDERMAN, ARVID EUGEN (MD)
Entity type:Individual
Prefix:DR
First Name:ARVID
Middle Name:EUGEN
Last Name:UNDERMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4149 TRACY ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-3234
Mailing Address - Country:US
Mailing Address - Phone:323-665-1664
Mailing Address - Fax:626-397-2104
Practice Address - Street 1:711 FAIRMOUNT AVE
Practice Address - Street 2:ROOM 1-11
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3103
Practice Address - Country:US
Practice Address - Phone:626-397-3772
Practice Address - Fax:626-397-2104
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20739207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41048Medicare UPIN