Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A55704 | CA |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | A55704 | CA |
NPI | 1205944907 |
---|---|
Provider Name | Ashkan Imanzahrai |
First Address | Fresno, CA 93721-1431 |
Second Address | Fresno, CA 93701-2124 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 30/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A557040 | (05) | CA |
H95010 | (02) | CA |