=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154881522
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PEGAH JAHANGIRI MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/22/2019
-----------------------------------------------------
Last Update Date | 05/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1335 BUENAVENTURA BLVD
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-0160
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-287-9758
-----------------------------------------------------
Fax | 530-276-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3224 WOOD STREAM LN
-----------------------------------------------------
City | ELLICOTT CITY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21042-2242
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-603-9630
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | A187585
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 0101284618
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------