Provider Demographics
NPI:1821262247
Name:PAYVANDI, SOHEIL ALI (DO)
Entity Type:Individual
Prefix:
First Name:SOHEIL
Middle Name:ALI
Last Name:PAYVANDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 K ST
Mailing Address - Street 2:310
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-454-6677
Mailing Address - Fax:916-733-8741
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:310
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-454-6677
Practice Address - Fax:916-733-8741
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8936207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821262247Medicaid
CAZZZ00355YOtherMEDICARE PTAN