Healthcare Provider Details

I. General information

NPI: 1003015652
Provider Name (Legal Business Name): ZIA AHMAD DEHQANZADA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 08/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 442 BOX 291
APO AE
09042
US

IV. Provider business mailing address

359 REDWING DR
WOODLAND CA
95695-5868
US

V. Phone/Fax

Practice location:
  • Phone: 496221173440
  • Fax: 496221173427
Mailing address:
  • Phone: 916-817-7268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101233249
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: