Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | A145994 | CA |
N | 208000000X | Pediatrician | A145994 | CA |
NPI | 1174919609 |
---|---|
Provider Name | Mahnoosh Nik-Ahd |
First Address | Oakland, CA 94609-1809 |
Second Address | Oakland, CA 94609-1809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2015 |
Last Update Date | 09/11/2021 |