Provider Demographics
NPI:1861479768
Name:KAZEMI, MUSTAFA MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MUSTAFA
Middle Name:MICHAEL
Last Name:KAZEMI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:M
Other - Middle Name:MICHAEL
Other - Last Name:KAZEMI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5401 NORRIS CANYON RD
Mailing Address - Street 2:308
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583
Mailing Address - Country:US
Mailing Address - Phone:925-866-8822
Mailing Address - Fax:925-866-8323
Practice Address - Street 1:5401 NORRIS CANYON RD
Practice Address - Street 2:308
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583
Practice Address - Country:US
Practice Address - Phone:925-866-8822
Practice Address - Fax:925-866-8323
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 61310207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G613101Medicaid
00G613100Medicare ID - Type Unspecified
E91898Medicare UPIN