Provider Demographics
NPI:1083623664
Name:ASADI, SIMA (MD)
Entity Type:Individual
Prefix:
First Name:SIMA
Middle Name:
Last Name:ASADI
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:PO BOX 2896
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-0896
Mailing Address - Country:US
Mailing Address - Phone:209-383-3671
Mailing Address - Fax:209-383-4037
Practice Address - Street 1:1100 OLIVEWOOD DR
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-1210
Practice Address - Country:US
Practice Address - Phone:209-383-3671
Practice Address - Fax:209-383-4037
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063923208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7965232Medicare UPIN