Provider Demographics
NPI:1770572109
Name:KAMYAR, ROKAY (MD)
Entity type:Individual
Prefix:DR
First Name:ROKAY
Middle Name:
Last Name:KAMYAR
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 1:8860 CENTER DR
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3068
Mailing Address - Country:US
Mailing Address - Phone:619-460-4055
Mailing Address - Fax:619-460-5145
Practice Address - Street 1:8860 CENTER DR
Practice Address - Street 2:SUITE 330
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3068
Practice Address - Country:US
Practice Address - Phone:619-460-4055
Practice Address - Fax:619-460-5145
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35485207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1770572109OtherMEDICARE NPI
CAA27800Medicare UPIN