Provider Demographics
NPI:1336484104
Name:PAYAMI, MADDIHA (DO)
Entity Type:Individual
Prefix:DR
First Name:MADDIHA
Middle Name:
Last Name:PAYAMI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2350 W EL CAMINO REAL FL 2
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-6203
Mailing Address - Country:US
Mailing Address - Phone:510-204-5256
Mailing Address - Fax:510-506-7728
Practice Address - Street 1:4053 LONE TREE WAY STE 101
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94531-6210
Practice Address - Country:US
Practice Address - Phone:510-204-5256
Practice Address - Fax:510-506-7728
Is Sole Proprietor?:No
Enumeration Date:2012-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A14012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A14012OtherSTATE MEDICAL LICENSE
CAFP5116214OtherFEDERAL DEA LICENSE