Provider Demographics
NPI:1396737003
Name:NEZHAT, AZADEH (MD)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:NEZHAT
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 1:1775 WOODSIDE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94061-3454
Mailing Address - Country:US
Mailing Address - Phone:650-327-8778
Mailing Address - Fax:650-327-2794
Practice Address - Street 1:1775 WOODSIDE RD STE 202
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94061-3454
Practice Address - Country:US
Practice Address - Phone:650-327-8778
Practice Address - Fax:650-327-2794
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC54221207VG0400X
GA047630174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000900248JMedicaid
GA000900248FMedicaid
GA000900248DMedicaid
GA000900248EMedicaid
GAH21994Medicare UPIN