Healthcare Provider Details

I. General information

NPI: 1295709046
Provider Name (Legal Business Name): SEPIDEH MOAYED MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 03/12/2021
Certification Date: 03/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 CAMDEN AVE STE 203
SAN JOSE CA
95124-2029
US

IV. Provider business mailing address

2242 CAMDEN AVE STE 203
SAN JOSE CA
95124-2029
US

V. Phone/Fax

Practice location:
  • Phone: 408-992-5141
  • Fax: 408-796-7492
Mailing address:
  • Phone: 408-992-5141
  • Fax: 408-796-7492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberA77967
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA77967
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License NumberA77967
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License NumberA77967
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA77967
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code2083S0010X
TaxonomySports Medicine (Preventive Medicine) Physician
License NumberA77967
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA77967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: