MEDICARE: MOJGAN EBADI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	A61584	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285712257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOJGAN EBADI M.D.

Provider Business Mailing Address
First Line	:	1690 WOODSIDE RD
Second Line	:	#102
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3497
Country	:	US
Telephone Number	:	650-568-5800
Fax Number	:	650-568-5802

Provider Business Practice Location Address
First Line	:	1690 WOODSIDE RD
Second Line	:	#102
City	:	REDWOOD CITY
State	:	CA
Zip	:	94061-3497
Country	:	US
Telephone Number	:	650-568-5800
Fax Number	:	650-568-5802

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	06/09/2010

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