Provider Demographics
NPI:1205878642
Name:SADRI, KATAYOUN (MD)
Entity type:Individual
Prefix:
First Name:KATAYOUN
Middle Name:
Last Name:SADRI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 CAMPISI CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-3107
Mailing Address - Country:US
Mailing Address - Phone:650-804-0496
Mailing Address - Fax:
Practice Address - Street 1:6881 CAMPISI CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-3107
Practice Address - Country:US
Practice Address - Phone:650-804-0496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85562208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics