Basic Information
| Provider Information | |||||||||
| NPI: | 1902396021 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YAZDAN | ||||||||
| FirstName: | ANTORA | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5620 AGER RD STE 2312 | ||||||||
| Address2: | |||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207823729 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | KAISER PERMANENTE WEST HYATTSVILLE MEDICAL CENTER | ||||||||
| Address2: | 5620 AGER RD | ||||||||
| City: | HYATTSVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007777904 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2018 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207Q00000X | H91414 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.