Provider Demographics
NPI:1043578610
Name:QAZI, NADIR YUSAF (DO)
Entity Type:Individual
Prefix:
First Name:NADIR
Middle Name:YUSAF
Last Name:QAZI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WATERWORKS WAY STE 105
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3171
Mailing Address - Country:US
Mailing Address - Phone:949-336-7293
Mailing Address - Fax:
Practice Address - Street 1:113 WATERWORKS WAY STE 105
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3171
Practice Address - Country:US
Practice Address - Phone:949-336-7293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14129207R00000X, 207N00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program