Provider Demographics
NPI:1669478491
Name:MAHMOUDI, JAHANGIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:
Last Name:MAHMOUDI
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 1:1290 LINCOLN RD
Mailing Address - Street 2:STE 2
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6553
Mailing Address - Country:US
Mailing Address - Phone:530-674-7655
Mailing Address - Fax:530-674-7657
Practice Address - Street 1:1290 LINCOLN RD
Practice Address - Street 2:STE 2
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-6553
Practice Address - Country:US
Practice Address - Phone:530-674-7655
Practice Address - Fax:530-674-7657
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA-29722207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A297220Medicaid
CA00A297220Medicaid
CAA87274Medicare UPIN