| Organization Name: | YAMA A DEHQANZADA DPM PC |
| NPI Number: | 1215122833 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | YAMA AHMAD DEHQANZADA (CEO/PRESIDENT) |
| Mailing Address: | 16770 Sw Edy Rd Suite 216 Sherwood |
| State: | OR US |
| Postal Code: | 971409678 |
| Phone Number: | 5039258120 |
| Fax Number: | 5039258121 |
| NPI Enumeration Date: | 09/06/2007 |
| NPI Last Update Date: | 09/06/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP1100X |
| License Number: | DP00348 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Podiatric |
| Taxonomy Definition: | |