Individual
DR. MIKE M HEYDARI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2460 MISSION ST STE 208, SAN FRANCISCO, CA 94110-2476
(408) 347-1680
(408) 347-1681
Mailing address
1644 ALUM ROCK AVE, SAN JOSE, CA 95116-2429
(408) 347-1680
(408) 347-1681
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
A40606
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A406060
MEDICAL BOARD NUMBER
CA
05
—
GR0070180
—
CA
05
—
GR0070181
—
CA
05
—
GR0070182
—
CA
01
—
ZZZ41448Z
BLUE SHIELD NUMBER
CA
Enumeration date
09/21/2006
Last updated
07/09/2007
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