Provider Demographics
NPI:1578510715
Name:YAZDANI, KAMBIZ (MD)
Entity type:Individual
Prefix:DR
First Name:KAMBIZ
Middle Name:
Last Name:YAZDANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KAMBIZ
Other - Middle Name:
Other - Last Name:YAZDANI-NAJAFABADI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1990 OLD BRIDGE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2383
Mailing Address - Country:US
Mailing Address - Phone:703-492-6822
Mailing Address - Fax:
Practice Address - Street 1:1990 OLD BRIDGE RD STE 201
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2383
Practice Address - Country:US
Practice Address - Phone:703-492-6822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237219174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI26987Medicare UPIN