Provider Demographics
NPI:1861990988
Name:PADEGANEH, ABBAS (PHD, FACMG)
Entity type:Individual
Prefix:DR
First Name:ABBAS
Middle Name:
Last Name:PADEGANEH
Suffix:
Gender:M
Credentials:PHD, FACMG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12060 HOFFMAN ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4716
Mailing Address - Country:US
Mailing Address - Phone:864-993-9283
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-218-3896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTO01006415207SC0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SC0300XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Cytogenetics