1215122833 NPI number — YAMA A DEHQANZADA DPM PC

Table of content: (NPI 1215122833)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215122833 NPI number — YAMA A DEHQANZADA DPM PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YAMA A DEHQANZADA DPM PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1215122833
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16770 SW EDY RD
Provider Second Line Business Mailing Address:
SUITE 216
Provider Business Mailing Address City Name:
SHERWOOD
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97140-9678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-925-8120
Provider Business Mailing Address Fax Number:
503-925-8121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16770 SW EDY RD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
SHERWOOD
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97140-9678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-925-8120
Provider Business Practice Location Address Fax Number:
503-925-8121
Provider Enumeration Date:
09/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DEHQANZADA
Authorized Official First Name:
YAMA
Authorized Official Middle Name:
AHMAD
Authorized Official Title or Position:
CEO/PRESIDENT
Authorized Official Telephone Number:
503-925-8120

Provider Taxonomy Codes

  • Taxonomy code: 261QP1100X , with the licence number:  DP00348 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1154338275 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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