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General NPI Number Information
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NPI Number | 1972602464
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Entity Type | Individual
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Provider Name | MIKE M HEYDARI M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 2460 MISSION ST STE 208
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City | SAN FRANCISCO
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State | CA
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Zip | 94110-2476
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Country | US
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Telephone | 408-347-1680
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Fax | 408-347-1681
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Provider Business Mailing Address
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Address Line | 1644 ALUM ROCK AVE
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City | SAN JOSE
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State | CA
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Zip | 95116-2429
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Country | US
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Telephone | 408-347-1680
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Fax | 408-347-1681
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A40606
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License Number State | CA
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