Provider Demographics
NPI:1336400712
Name:NIKSIAR, SIMIN
Entity type:Individual
Prefix:MS
First Name:SIMIN
Middle Name:
Last Name:NIKSIAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 SEMINARY DR APT G
Mailing Address - Street 2:
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3133
Mailing Address - Country:US
Mailing Address - Phone:415-819-7542
Mailing Address - Fax:
Practice Address - Street 1:2400 MOORPARK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2631
Practice Address - Country:US
Practice Address - Phone:408-975-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-01
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program