Provider Demographics
NPI:1801106752
Name:JAHANGIR MAHMOUDI,M.D.INC
Entity type:Organization
Organization Name:JAHANGIR MAHMOUDI,M.D.INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAHANGIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOUDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:530-674-7655
Mailing Address - Street 1:1290 LINCOLN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-6735
Mailing Address - Country:US
Mailing Address - Phone:530-674-7655
Mailing Address - Fax:530-674-7567
Practice Address - Street 1:1290 LINCOLN RD STE 2
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-6735
Practice Address - Country:US
Practice Address - Phone:530-674-7655
Practice Address - Fax:530-674-7567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-13
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA297222084N0400X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A297220Medicaid
CA00A297220Medicare PIN
CA00A297220Medicaid