Provider Demographics
NPI:1659452969
Name:YADIDI, KAYVON K (DO)
Entity type:Individual
Prefix:DR
First Name:KAYVON
Middle Name:K
Last Name:YADIDI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:10573 W PICO BLVD # 328
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2333
Mailing Address - Country:US
Mailing Address - Phone:109-481-8013
Mailing Address - Fax:
Practice Address - Street 1:1400 S GRAND AVE STE 703
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3068
Practice Address - Country:US
Practice Address - Phone:323-408-8532
Practice Address - Fax:323-408-8534
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2025-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A65952083X0100X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG00124Medicare UPIN