Provider Demographics
NPI:1508808114
Name:KHAYAM-BASHI, SHIEVA CAMELLIA (MD)
Entity Type:Individual
Prefix:
First Name:SHIEVA
Middle Name:CAMELLIA
Last Name:KHAYAM-BASHI
Suffix:
Gender:F
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:PO BOX 27263
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-0263
Mailing Address - Country:US
Mailing Address - Phone:415-334-2500
Mailing Address - Fax:864-448-1425
Practice Address - Street 1:302 SILVER AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-1510
Practice Address - Country:US
Practice Address - Phone:415-334-2500
Practice Address - Fax:864-448-1425
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-11
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G806870Medicaid
CA080150717OtherRAILROAD MEDICARE
CA00G806870Medicaid