Provider Demographics
NPI:1316981061
Name:AZIMI, PARVIN HADJI (MD)
Entity type:Individual
Prefix:DR
First Name:PARVIN
Middle Name:HADJI
Last Name:AZIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 THE UPLANDS
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2833
Mailing Address - Country:US
Mailing Address - Phone:510-428-3336
Mailing Address - Fax:510-601-3957
Practice Address - Street 1:747 52 STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-428-3336
Practice Address - Fax:510-601-3957
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24963174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A249630Medicaid
CA00A249630Medicaid