Provider Demographics
NPI:1215021175
Name:JAHANGIRI, WASFA JABEEN (MD)
Entity Type:Individual
Prefix:
First Name:WASFA
Middle Name:JABEEN
Last Name:JAHANGIRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:WASFA
Other - Middle Name:
Other - Last Name:JABEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 22210
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94623-2210
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4189
Practice Address - Street 1:243 GEORGIA STREET
Practice Address - Street 2:STE B
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590
Practice Address - Country:US
Practice Address - Phone:707-556-8100
Practice Address - Fax:707-556-8107
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90365207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC70543GMedicaid
CAFHC70543GMedicaid
CJ444AMedicare PIN
CAI26857Medicare UPIN