Provider Demographics
NPI:1467407809
Name:ELYASI, SIAMAK (MD)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:ELYASI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2220 GLADSTONE DR
Mailing Address - Street 2:STE 3
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5123
Mailing Address - Country:US
Mailing Address - Phone:925-779-9601
Mailing Address - Fax:925-432-4590
Practice Address - Street 1:2220 GLADSTONE DR
Practice Address - Street 2:SUITE 3
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5123
Practice Address - Country:US
Practice Address - Phone:925-779-9601
Practice Address - Fax:925-432-4590
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-24
Last Update Date:2019-08-26
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Provider Licenses
StateLicense IDTaxonomies
CAA50205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A502050Medicaid
F24050Medicare UPIN