Provider Demographics
NPI:1659307387
Name:MOSHIRNIA, DJAMSHID (MD)
Entity Type:Individual
Prefix:DR
First Name:DJAMSHID
Middle Name:
Last Name:MOSHIRNIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 W BENJAMIN HOLT DR STE 200A
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3839
Mailing Address - Country:US
Mailing Address - Phone:209-943-0168
Mailing Address - Fax:209-943-0416
Practice Address - Street 1:555 W BENJAMIN HOLT DR STE 200A
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-3839
Practice Address - Country:US
Practice Address - Phone:209-943-0168
Practice Address - Fax:209-943-0416
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33715207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A337150Medicaid
CAA27229Medicare UPIN
CA00A337150Medicaid