Provider Demographics
NPI:1700839818
Name:AMJADI, FIROOZ B (MD)
Entity Type:Individual
Prefix:DR
First Name:FIROOZ
Middle Name:B
Last Name:AMJADI
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 1:2701 CHESTER AVE
Mailing Address - Street 2:STE # 202
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2016
Mailing Address - Country:US
Mailing Address - Phone:661-716-9410
Mailing Address - Fax:661-716-9415
Practice Address - Street 1:1921 18TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4205
Practice Address - Country:US
Practice Address - Phone:661-324-2491
Practice Address - Fax:661-324-9406
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00464981OtherINDIVIDUAL RAILROAD
CAG99669Medicare UPIN
CA0482850001Medicare NSC
CAZZZ23437ZMedicare PIN