Provider Demographics
NPI:1780074179
Name:QORBANI, AMIR (MD)
Entity type:Individual
Prefix:DR
First Name:AMIR
Middle Name:
Last Name:QORBANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AMIR
Other - Middle Name:
Other - Last Name:GHORBANI AGHBOLAGHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3 MABREY CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94124-2485
Mailing Address - Country:US
Mailing Address - Phone:949-609-9916
Mailing Address - Fax:
Practice Address - Street 1:1825 4TH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2350
Practice Address - Country:US
Practice Address - Phone:949-609-9916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-23
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA147440207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program