Provider Demographics
NPI:1538243373
Name:MALAKOOTI, HAMID (MD)
Entity type:Individual
Prefix:DR
First Name:HAMID
Middle Name:
Last Name:MALAKOOTI
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 1:2428 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3041
Mailing Address - Country:US
Mailing Address - Phone:323-722-5550
Mailing Address - Fax:323-722-0704
Practice Address - Street 1:2428 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3041
Practice Address - Country:US
Practice Address - Phone:323-722-5550
Practice Address - Fax:323-722-0704
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40504208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A405040Medicaid
CA954216264OtherTAX ID
CAA40504Medicare ID - Type UnspecifiedMEDICAL LIC #
CA00A405040Medicaid