Provider Demographics
NPI:1407947021
Name:JAHADI, KAMBIZ (MD)
Entity Type:Individual
Prefix:
First Name:KAMBIZ
Middle Name:
Last Name:JAHADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 CHISHOLM TRL STE C
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2903
Mailing Address - Country:US
Mailing Address - Phone:512-248-9090
Mailing Address - Fax:
Practice Address - Street 1:1402 CHISHOLM TRL STE C
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2903
Practice Address - Country:US
Practice Address - Phone:512-248-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6019208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00391GOtherBCBS IDENTIFIER
TX030205101Medicaid
TX00391GOtherBCBS IDENTIFIER
TX00391GMedicare ID - Type Unspecified
TXG80525Medicare UPIN