Provider Demographics
NPI:1295709046
Name:MOAYED, SEPIDEH (MD)
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:MOAYED
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2242 CAMDEN AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2029
Mailing Address - Country:US
Mailing Address - Phone:408-992-5141
Mailing Address - Fax:408-796-7492
Practice Address - Street 1:2242 CAMDEN AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2029
Practice Address - Country:US
Practice Address - Phone:408-992-5141
Practice Address - Fax:408-796-7492
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA779672085P0229X, 2085R0202X, 2085U0001X, 2083A0300X, 2085B0100X, 2083S0010X, 2085N0700X
261QM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A779670Medicare ID - Type Unspecified
H20384Medicare UPIN