Healthcare Provider Details

I. General information

NPI: 1750574034
Provider Name (Legal Business Name): ZOHREH AZADFAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 S WHITE RD
SAN JOSE CA
95127-4758
US

IV. Provider business mailing address

2670 S WHITE RD SUITE 200
SAN JOSE CA
95148-2071
US

V. Phone/Fax

Practice location:
  • Phone: 408-729-9700
  • Fax:
Mailing address:
  • Phone: 408-729-4290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA98808
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA98808
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: