Basic Information
Provider Information
NPI: 1790977726
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TEIMOORI NOBANDEGANI
FirstName: SEEYAM
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: TEIMOORI NOBANDEGANI
OtherFirstName: SEEYAM
OtherMiddleName:  
OtherNamePrefix: DR.
OtherNameSuffix:  
OtherCredential: MD
OtherLastNameType: 5
Mailing Information
Address1: 2008 N GAREY AVE
Address2:  
City: POMONA
State: CA
PostalCode: 917672722
CountryCode: US
TelephoneNumber: 9096236131
FaxNumber:  
Practice Location
Address1: 2008 N GAREY AVE
Address2:  
City: POMONA
State: CA
PostalCode: 917672722
CountryCode: US
TelephoneNumber: 9096236131
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/14/2007
LastUpdateDate: 09/29/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800XA 118840CAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
207Q00000XA118840CAN Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


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