Healthcare Provider Details

I. General information

NPI: 1093703944
Provider Name (Legal Business Name): JAFAR GOLZARIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/28/2025
Certification Date: 03/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 GOLDEN VALLEY RD STE 340
GOLDEN VALLEY MN
55427-4488
US

IV. Provider business mailing address

PO BOX 860856
MINNEAPOLIS MN
55486-0856
US

V. Phone/Fax

Practice location:
  • Phone: 952-960-9399
  • Fax: 952-206-6467
Mailing address:
  • Phone: 952-960-9399
  • Fax: 952-206-6467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number50506
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number50506
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: