Provider Demographics
NPI:1720475205
Name:YAGHOOTI, NEGAR (MD)
Entity type:Individual
Prefix:
First Name:NEGAR
Middle Name:
Last Name:YAGHOOTI
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 1:1720 EL CAMINO REAL STE 155
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3231
Mailing Address - Country:US
Mailing Address - Phone:650-342-6506
Mailing Address - Fax:650-340-9032
Practice Address - Street 1:1720 EL CAMINO REAL STE 155
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3231
Practice Address - Country:US
Practice Address - Phone:650-342-6506
Practice Address - Fax:650-340-9032
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2019-0526207R00000X, 207R00000X
CAA143855207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANY3232267556Medicaid