Provider Demographics
NPI:1194805101
Name:ZANDIFAR, PARVIZ (LAC,PHD)
Entity type:Individual
Prefix:PROF
First Name:PARVIZ
Middle Name:
Last Name:ZANDIFAR
Suffix:
Gender:M
Credentials:LAC,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1961 PRUNERIDGE AVE
Mailing Address - Street 2:STE B-1
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6575
Mailing Address - Country:US
Mailing Address - Phone:408-292-4391
Mailing Address - Fax:
Practice Address - Street 1:1961 PRUNERIDGE AVE
Practice Address - Street 2:STE B-1
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95050-6575
Practice Address - Country:US
Practice Address - Phone:408-292-4391
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 5681171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 0056810Medicaid