Provider Demographics
NPI:1326209461
Name:MOGHADDAM, BILLUR (MD)
Entity Type:Individual
Prefix:
First Name:BILLUR
Middle Name:
Last Name:MOGHADDAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:916-784-4000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:2825 50TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2310
Practice Address - Country:US
Practice Address - Phone:916-703-0413
Practice Address - Fax:916-703-0417
Is Sole Proprietor?:No
Enumeration Date:2008-06-20
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA89124207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)