Provider Demographics
NPI:1548340474
Name:ZAKHIREH, MOHAMMED ALI (MD)
Entity type:Individual
Prefix:
First Name:MOHAMMED
Middle Name:ALI
Last Name:ZAKHIREH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2010
Mailing Address - Street 2:
Mailing Address - City:ROSS
Mailing Address - State:CA
Mailing Address - Zip Code:94957-2010
Mailing Address - Country:US
Mailing Address - Phone:415-207-0053
Mailing Address - Fax:
Practice Address - Street 1:1363 S ELISEO DR
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2012
Practice Address - Country:US
Practice Address - Phone:415-207-0053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85004208600000X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A850040Medicaid
CAI15557Medicare UPIN
CA00A850040Medicaid