Provider Demographics
NPI:1710788450
Name:BANIAMERIAN, PEDRAM
Entity type:Individual
Prefix:
First Name:PEDRAM
Middle Name:
Last Name:BANIAMERIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4675 STEVENS CREEK BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6763
Mailing Address - Country:US
Mailing Address - Phone:408-394-0288
Mailing Address - Fax:
Practice Address - Street 1:4675 STEVENS CREEK BLVD STE 121
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-6763
Practice Address - Country:US
Practice Address - Phone:408-394-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-20
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37117111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor