Provider Demographics
NPI:1376637199
Name:JAMASBI, BABAK JAHROMI (MD)
Entity Type:Individual
Prefix:
First Name:BABAK
Middle Name:JAHROMI
Last Name:JAMASBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:JAHROMI
Other - Last Name:JAMASBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1335 STANFORD AVE
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2536
Mailing Address - Country:US
Mailing Address - Phone:510-649-7000
Mailing Address - Fax:510-740-7769
Practice Address - Street 1:1335 STANFORD AVE
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1115
Practice Address - Country:US
Practice Address - Phone:510-649-7000
Practice Address - Fax:510-740-7769
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70042207L00000X, 207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR00G700420OtherBLUE SHIELD OF CALIFORNIA
CAZZZ20562ZOtherMEDICARE GROUP PROVIDER IDENTIFICATION NUMBER
CA050079793OtherRAILROAD MEDICARE
CAF22915Medicare UPIN
AR00G700420OtherBLUE SHIELD OF CALIFORNIA