Healthcare Provider Details

I. General information

NPI: 1427298199
Provider Name (Legal Business Name): MAIHAN AMIRYAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2009
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PINOLE VALLEY RD
PINOLE CA
94564-1384
US

IV. Provider business mailing address

1800 HARRISON ST 7TH FLOOR
OAKLAND CA
94612-3466
US

V. Phone/Fax

Practice location:
  • Phone: 510-243-4100
  • Fax:
Mailing address:
  • Phone: 510-625-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA106592
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: