Provider Demographics
NPI:1235285735
Name:MANZAR NEJAD, MOJAN (MD)
Entity Type:Individual
Prefix:
First Name:MOJAN
Middle Name:
Last Name:MANZAR NEJAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MOJGAN
Other - Middle Name:
Other - Last Name:MANZARNEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1580 VALENCIA STREET
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110
Mailing Address - Country:US
Mailing Address - Phone:415-641-6667
Mailing Address - Fax:415-641-6802
Practice Address - Street 1:1580 VALENCIA STREET
Practice Address - Street 2:SUITE 106
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110
Practice Address - Country:US
Practice Address - Phone:415-641-6667
Practice Address - Fax:415-641-6802
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I04211Medicare UPIN