Provider Demographics
NPI:1578788402
Name:VANDERWALDE, LINDI H (MD)
Entity type:Individual
Prefix:DR
First Name:LINDI
Middle Name:H
Last Name:VANDERWALDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LINDI
Other - Middle Name:HANNA
Other - Last Name:VANDERWALDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-9331
Practice Address - Fax:310-423-9399
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA949462086X0206X
TN50312208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR214525001Medicaid
MS02483050Medicaid
TN1532986Medicaid
AR214525001Medicaid