Provider Demographics
NPI:1003801358
Name:KHASHAYAR, RAMIN (MD)
Entity Type:Individual
Prefix:MR
First Name:RAMIN
Middle Name:
Last Name:KHASHAYAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
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Mailing Address - Street 1:1399 YGNACIO VALLEY RD
Mailing Address - Street 2:SUITE 14
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2884
Mailing Address - Country:US
Mailing Address - Phone:925-939-3050
Mailing Address - Fax:
Practice Address - Street 1:1399 YGNACIO VALLEY RD
Practice Address - Street 2:STE 14
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2884
Practice Address - Country:US
Practice Address - Phone:925-939-3050
Practice Address - Fax:925-939-3057
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG077458207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
G19570Medicare UPIN
00G774580Medicare ID - Type Unspecified