Provider Demographics
NPI:1124133111
Name:ZIAIE MATIN, MARYAM (MD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:ZIAIE MATIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARYAM
Other - Middle Name:ZIAIE
Other - Last Name:MATIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1900 GOUGH ST
Mailing Address - Street 2:#401
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3491
Mailing Address - Country:US
Mailing Address - Phone:415-464-1771
Mailing Address - Fax:415-464-1158
Practice Address - Street 1:501 VIA CASITAS
Practice Address - Street 2:
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-1901
Practice Address - Country:US
Practice Address - Phone:415-464-1771
Practice Address - Fax:415-464-1158
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78803207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A788030Medicare PIN
H99213Medicare UPIN