MEDICARE: DR. JALEH NIAZI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	G79850	CA

General Provider Information

NPI Number	:	1053300988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JALEH NIAZI M.D.

Provider Business Mailing Address
First Line	:	900 COLUSA AVE STE 204
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2321
Country	:	US
Telephone Number	:	510-465-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	900 COLUSA AVE STE 204
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94707-2321
Country	:	US
Telephone Number	:	510-465-4445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2005
Last Update Date	:	09/26/2016

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