Provider Demographics
NPI:1841409612
Name:DANESH MEDICAL OFFICE PC
Entity Type:Organization
Organization Name:DANESH MEDICAL OFFICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALI
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANESH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-984-6100
Mailing Address - Street 1:1600 CREEKSIDE DR STE 3600
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3446
Mailing Address - Country:US
Mailing Address - Phone:916-984-6100
Mailing Address - Fax:916-984-6129
Practice Address - Street 1:1600 CREEKSIDE DR
Practice Address - Street 2:SUITE 3600
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3444
Practice Address - Country:US
Practice Address - Phone:916-984-6100
Practice Address - Fax:916-984-6129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75706207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty