Provider Demographics
NPI:1104000694
Name:YAZDY-SOKHANDAN PA
Entity Type:Organization
Organization Name:YAZDY-SOKHANDAN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAHIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-627-5337
Mailing Address - Street 1:357 WOODRUFF RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-3415
Mailing Address - Country:US
Mailing Address - Phone:864-627-5337
Mailing Address - Fax:864-627-9301
Practice Address - Street 1:357 WOODRUFF RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3415
Practice Address - Country:US
Practice Address - Phone:864-627-5337
Practice Address - Fax:864-627-9301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2017-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17953174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT20518Medicaid
SCP00194436Medicare PIN
SCF72654Medicare UPIN
SC6996Medicare PIN
SC6995Medicare PIN