Provider Demographics
NPI:1780803106
Name:EGHDAMI, MERSEDEH (DC)
Entity type:Individual
Prefix:DR
First Name:MERSEDEH
Middle Name:
Last Name:EGHDAMI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1580 W EL CAMINO REAL
Mailing Address - Street 2:SUITE # 11
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2458
Mailing Address - Country:US
Mailing Address - Phone:650-960-0198
Mailing Address - Fax:650-960-0199
Practice Address - Street 1:1580 W EL CAMINO REAL
Practice Address - Street 2:SUITE # 11
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2458
Practice Address - Country:US
Practice Address - Phone:650-960-0198
Practice Address - Fax:650-960-0199
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC25689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU955277Medicare UPIN