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General NPI Number Information
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NPI Number | 1619203866
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Entity Type | Individual
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Provider Name | POOYAN B SADEGHI M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/22/2009
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 39 MONTELL ST
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City | OAKLAND
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State | CA
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Zip | 94611-4923
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Country | US
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Telephone | 415-306-3432
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Fax |
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Provider Business Mailing Address
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Address Line | 3871 PIEDMONT AVE # 105
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City | OAKLAND
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State | CA
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Zip | 94611-5378
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A109567
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License Number State | CA
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