Healthcare Provider Details

I. General information

NPI: 1033732540
Provider Name (Legal Business Name): KIMIA YAVARI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2020
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST STE 100
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y ST STE 100
SACRAMENTO CA
95817-2307
US

V. Phone/Fax

Practice location:
  • Phone: 530-752-2884
  • Fax:
Mailing address:
  • Phone: 530-752-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA190848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: