Provider Demographics
NPI:1497879522
Name:MEHDI DOROODGAR MD INC
Entity Type:Organization
Organization Name:MEHDI DOROODGAR MD INC
Other - Org Name:MEHDI DOROODGAR MD INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROODGAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-297-8422
Mailing Address - Street 1:25 N 14TH ST
Mailing Address - Street 2:SUITE 840
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6204
Mailing Address - Country:US
Mailing Address - Phone:408-297-8422
Mailing Address - Fax:408-297-8622
Practice Address - Street 1:25 N 14TH ST
Practice Address - Street 2:SUITE 840
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6204
Practice Address - Country:US
Practice Address - Phone:408-297-8422
Practice Address - Fax:408-297-8622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26298Medicare UPIN