Basic Information
| Provider Information | |||||||||
| NPI: | 1821262247 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAYVANDI | ||||||||
| FirstName: | SOHEIL | ||||||||
| MiddleName: | ALI | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 K ST | ||||||||
| Address2: | 310 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164546677 | ||||||||
| FaxNumber: | 9167338741 | ||||||||
| Practice Location | |||||||||
| Address1: | 2801 K ST | ||||||||
| Address2: | 310 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958165120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164546677 | ||||||||
| FaxNumber: | 9167338741 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 03/12/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 20A8936 | CA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XS0106X | 20A8936 | CA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1821262247 | 05 | CA | MEDICAID | ZZZ00355Y | 01 | CA | MEDICARE PTAN | OTHER |