Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A89124 | CA |
NPI | 1326209461 |
---|---|
Provider Name | Billur Moghaddam |
First Address | Oakland, CA 94612-3466 |
Second Address | Sacramento, CA 95817-2310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2008 |
Last Update Date | 22/12/2021 |