Provider Demographics
NPI:1417299595
Name:GHADJAR, KIUMARS GHAHREMANI (MD)
Entity Type:Individual
Prefix:DR
First Name:KIUMARS
Middle Name:GHAHREMANI
Last Name:GHADJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIU
Other - Middle Name:
Other - Last Name:GHADJAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:751 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:408-885-5110
Mailing Address - Fax:408-885-6317
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5110
Practice Address - Fax:408-885-6317
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA133673207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program