Healthcare Provider Details

I. General information

NPI: 1801106752
Provider Name (Legal Business Name): JAHANGIR MAHMOUDI,M.D.INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2010
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1290 LINCOLN RD STE 2
YUBA CITY CA
95991-6735
US

IV. Provider business mailing address

1290 LINCOLN RD STE 2
YUBA CITY CA
95991-6735
US

V. Phone/Fax

Practice location:
  • Phone: 530-674-7655
  • Fax: 530-674-7567
Mailing address:
  • Phone: 530-674-7655
  • Fax: 530-674-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA29722
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA29722
License Number StateCA

VIII. Authorized Official

Name: DR. JAHANGIR MAHMOUDI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 530-674-7655