Healthcare Provider Details

I. General information

NPI: 1205330685
Provider Name (Legal Business Name): AHDAD ZIYAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 11/28/2025
Certification Date: 11/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N TUSTIN AVE STE 605
SANTA ANA CA
92705-3610
US

IV. Provider business mailing address

1702 E UTAH AVE
FRESNO CA
93720-1967
US

V. Phone/Fax

Practice location:
  • Phone: 714-584-9930
  • Fax:
Mailing address:
  • Phone: 559-709-9257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License NumberA164647
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA164647
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: