Provider Demographics
NPI:1912980699
Name:MOHAMMADIAN, YAHYA (MD)
Entity Type:Individual
Prefix:
First Name:YAHYA
Middle Name:
Last Name:MOHAMMADIAN
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:THREE MEDICAL PLAZA
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3088
Mailing Address - Country:US
Mailing Address - Phone:916-733-3777
Mailing Address - Fax:916-454-6780
Practice Address - Street 1:THREE MEDICAL PLAZA
Practice Address - Street 2:SUITE 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3088
Practice Address - Country:US
Practice Address - Phone:916-733-3777
Practice Address - Fax:916-454-6780
Is Sole Proprietor?:No
Enumeration Date:2005-11-27
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86902207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A869020OtherMEDI-CAL
CAI24308Medicare UPIN
CA00A869020Medicare PIN