Provider Demographics
NPI:1528022852
Name:KHALILNEJADI, HEIDEH SEDIGHEH (MD)
Entity Type:Individual
Prefix:
First Name:HEIDEH
Middle Name:SEDIGHEH
Last Name:KHALILNEJADI
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 1:1210E ARQUES AVE 203
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5422
Mailing Address - Country:US
Mailing Address - Phone:408-738-0200
Mailing Address - Fax:408-738-1700
Practice Address - Street 1:751 S BASCOM AVE
Practice Address - Street 2:URGENT CARE CLINIC
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2604
Practice Address - Country:US
Practice Address - Phone:408-885-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA65025207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A650250Medicaid
CAG85834Medicare UPIN
CA00A650250Medicaid