Provider Demographics
NPI:1972166379
Name:YAZDANI, NIKI (MD)
Entity type:Individual
Prefix:
First Name:NIKI
Middle Name:
Last Name:YAZDANI
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 1:1513 LABUMUM AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227
Mailing Address - Country:US
Mailing Address - Phone:225-975-1176
Mailing Address - Fax:
Practice Address - Street 1:DIVISION OF HOSPITAL MEDICINE, DEPARTMENT OF INTERNAL M
Practice Address - Street 2:1250 E MARSHALL ST
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:225-975-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-21
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101275132207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program