Provider Demographics
NPI:1285478834
Name:AHMADZADA, AHMAD WAHEED (OD)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:WAHEED
Last Name:AHMADZADA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 FELDIN CT
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-8451
Mailing Address - Country:US
Mailing Address - Phone:916-226-7378
Mailing Address - Fax:
Practice Address - Street 1:2295 KIETZKE LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3604
Practice Address - Country:US
Practice Address - Phone:775-328-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-19
Last Update Date:2024-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35744390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program