Mehrdad Amirhamzeh, M.D., Inc.

Primary specialty

Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X

License

G86572 Issued in CA

Legal business name

MEHRDAD AMIRHAMZEH, M.D., INC.

Practice address

1610 W Yosemite Ave
Suite 3
Manteca, CA 95337-5189

Phone

(209) 665-4412

Fax

(209) 665-4415

NPI assigned

Aug 31, 2006

Last updated

Aug 22, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mehrdad Amirhamzeh, M.D.NPI 1174523096

Title

President

Phone

(209) 665-4412

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mehrdad M.R. Amirhamzeh, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Manteca, CA
  • NPI 1174523096
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1377129600000",
    "number": "1144331224",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1610 W YOSEMITE AVE",
            "address_2": "SUITE 3",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953375189",
            "telephone_number": "209-665-4412",
            "fax_number": "209-665-4415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 W YOSEMITE AVE",
            "address_2": "SUITE 3",
            "city": "MANTECA",
            "state": "CA",
            "postal_code": "953375189",
            "telephone_number": "209-665-4412",
            "fax_number": "209-665-4415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEHRDAD AMIRHAMZEH, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2013-08-22",
        "status": "A",
        "authorized_official_last_name": "AMIRHAMZEH",
        "authorized_official_first_name": "MEHRDAD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "209-665-4412",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "CA",
            "license": "G86572",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00G865720",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "ZZZ03769Z",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in Manteca, CA
• Providers in Manteca, CA by specialty
• Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.