Provider Demographics
NPI:1710134465
Name:EBRAHIM AHMADI, M D INC.
Entity Type:Organization
Organization Name:EBRAHIM AHMADI, M D INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:EBRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-791-2002
Mailing Address - Street 1:38143 MARTHA AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-3800
Mailing Address - Country:US
Mailing Address - Phone:510-791-2002
Mailing Address - Fax:
Practice Address - Street 1:38143 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3800
Practice Address - Country:US
Practice Address - Phone:510-791-2002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO50313261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A503131Medicaid
CA00A503130Medicare PIN