Provider Demographics
NPI:1689782245
Name:SADEGHI, JAHANGIR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAHANGIR
Middle Name:
Last Name:SADEGHI
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 1:950 NORTHGATE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-3414
Mailing Address - Country:US
Mailing Address - Phone:415-479-2372
Mailing Address - Fax:415-472-6225
Practice Address - Street 1:950 NORTHGATE DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-3433
Practice Address - Country:US
Practice Address - Phone:415-479-2372
Practice Address - Fax:415-472-6225
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA483-265146207W00000X
CAC50518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA483265146OtherSTATE ID
CAC50518OtherMEDICAL LICENSE NUMBER
CAC50518OtherMEDICAL LICENSE NUMBER
CAOOC505180Medicare ID - Type Unspecified
CAB18046Medicare UPIN