Provider Demographics
NPI:1942543681
Name:POURTAHERI, NAVID (MD, PHD)
Entity type:Individual
Prefix:
First Name:NAVID
Middle Name:
Last Name:POURTAHERI
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 DIVISADERO ST.
Mailing Address - Street 2:PMB 759
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2213
Mailing Address - Country:US
Mailing Address - Phone:415-523-5235
Mailing Address - Fax:415-523-5235
Practice Address - Street 1:490 POST ST STE 1701
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1308
Practice Address - Country:US
Practice Address - Phone:415-523-5235
Practice Address - Fax:415-523-5235
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-01
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01083848A208200000X, 2082S0099X
CT1.0629652086S0122X
CAA167926208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery