1790122307 NPI number — SAIYID-NAUFAL T ZAIDI MD

Table of content: SAIYID-NAUFAL T ZAIDI MD (NPI 1790122307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790122307 NPI number — SAIYID-NAUFAL T ZAIDI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZAIDI
Provider First Name:
SAIYID-NAUFAL
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790122307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 PRESTIGE PL STE 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMISBURG
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45342-6115
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-762-1310
Provider Business Mailing Address Fax Number:
937-522-8493

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 W CALIFORNIA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-3010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-792-2166
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/23/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  E-8946 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: 35.129314 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X , with the licence number: C177218 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)