Provider Demographics
NPI:1841356664
Name:RAISZADEH, KAMSHAD (MD)
Entity type:Individual
Prefix:DR
First Name:KAMSHAD
Middle Name:
Last Name:RAISZADEH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7525 METROPOLITAN DR STE 306
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4404
Mailing Address - Country:US
Mailing Address - Phone:619-275-7460
Mailing Address - Fax:866-813-1235
Practice Address - Street 1:7525 METROPOLITAN DR STE 306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4404
Practice Address - Country:US
Practice Address - Phone:619-275-7460
Practice Address - Fax:866-813-1235
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74016207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74016OtherLICENSE NUMBER
CAG74016OtherLICENSE NUMBER
CAW15062Medicare ID - Type Unspecified