Provider Demographics
NPI:1861800633
Name:ABBAS MAHDAVI MD INC
Entity type:Organization
Organization Name:ABBAS MAHDAVI MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ABBAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHDAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-754-1200
Mailing Address - Street 1:3700 SUNSET LN STE 3
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-6123
Mailing Address - Country:US
Mailing Address - Phone:925-754-7200
Mailing Address - Fax:
Practice Address - Street 1:3700 SUNSET LN STE 3
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-6123
Practice Address - Country:US
Practice Address - Phone:925-754-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31325208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty