Basic Information
| Provider Information | |||||||||
| NPI: | 1114017340 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAZDANI-KACHOOEI | ||||||||
| FirstName: | PARVIN | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | CLINICAL CARE CENTER STE 1020 | ||||||||
| Address2: | 6621 FANNIN ST STE 1020 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328223781 | ||||||||
| FaxNumber: | 8328253903 | ||||||||
| Practice Location | |||||||||
| Address1: | CLINICAL CARE CENTER | ||||||||
| Address2: | 6621 FANNIN ST 11TH FLOOR | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328223670 | ||||||||
| FaxNumber: | 8328254858 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | G2515 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 115588905 | 05 | TX | MEDICAID |