Provider Demographics
NPI:1154338275
Name:DEHQANZADA, YAMA AHMAD (DPM)
Entity type:Individual
Prefix:
First Name:YAMA
Middle Name:AHMAD
Last Name:DEHQANZADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9900 SW HALL BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5843
Mailing Address - Country:US
Mailing Address - Phone:503-245-2420
Mailing Address - Fax:503-245-2445
Practice Address - Street 1:9900 SW HALL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-5843
Practice Address - Country:US
Practice Address - Phone:503-245-2420
Practice Address - Fax:503-245-2445
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00348213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR181413OtherOMAP NUMBER
U96890Medicare UPIN
OR181413OtherOMAP NUMBER