Provider Demographics
NPI:1790127298
Name:KERDAR, JEILA MARIE (PA)
Entity Type:Individual
Prefix:
First Name:JEILA
Middle Name:MARIE
Last Name:KERDAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:JEILA
Other - Middle Name:
Other - Last Name:KAKAVAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:R PA-C
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23 016726363A00000X
CA52220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant