Provider Demographics
NPI:1699956250
Name:HAMID M MEHDIZADEH, INC
Entity type:Organization
Organization Name:HAMID M MEHDIZADEH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HAMID
Authorized Official - Middle Name:M
Authorized Official - Last Name:MEHDIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-356-6600
Mailing Address - Street 1:2505 SAMARITAN DR
Mailing Address - Street 2:502
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-356-6600
Mailing Address - Fax:408-356-6697
Practice Address - Street 1:2505 SAMARITAN DR
Practice Address - Street 2:502
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4006
Practice Address - Country:US
Practice Address - Phone:408-356-6600
Practice Address - Fax:408-356-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-23
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00A29397174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE68947Medicare UPIN
CA00A29397Medicare PIN