Provider Demographics
NPI:1184605644
Name:AMIRI, AMIR (MD)
Entity type:Individual
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First Name:AMIR
Middle Name:
Last Name:AMIRI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:555 CAPITOL MALL STE 260
Mailing Address - Street 2:SURGICAL AFFILIATES MANAGEMENT GROUP
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-4503
Mailing Address - Country:US
Mailing Address - Phone:916-441-0400
Mailing Address - Fax:916-441-0406
Practice Address - Street 1:2315 STOCKTON BLVD
Practice Address - Street 2:UCDMC SURGERY HOUSESTAFF OFFICE ROOM 6309
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2201
Practice Address - Country:US
Practice Address - Phone:916-734-2724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2014-06-16
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Provider Licenses
StateLicense IDTaxonomies
CAA927432086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN