Provider Demographics
NPI:1982673976
Name:ZANDI, DARIUSH (MD)
Entity Type:Individual
Prefix:
First Name:DARIUSH
Middle Name:
Last Name:ZANDI
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 1:13851 E 14TH ST
Mailing Address - Street 2:STE 205
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2627
Mailing Address - Country:US
Mailing Address - Phone:510-674-0050
Mailing Address - Fax:510-357-3389
Practice Address - Street 1:13851 E 14TH ST
Practice Address - Street 2:STE 205
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2627
Practice Address - Country:US
Practice Address - Phone:510-674-0050
Practice Address - Fax:510-357-3389
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA81927207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A819271Medicare PIN
H96123Medicare UPIN