MEDICARE: MR. STEPHEN AMIR MASHHOON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	38560	CA

General Provider Information

NPI Number	:	1760502348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEPHEN AMIR MASHHOON DDS

Provider Business Mailing Address
First Line	:	5450 THORNWOOD DR STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1222
Country	:	US
Telephone Number	:	408-360-0270
Fax Number	:	408-360-0275

Provider Business Practice Location Address
First Line	:	5450 THORNWOOD DR STE B
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1222
Country	:	US
Telephone Number	:	408-360-0270
Fax Number	:	408-360-0275

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	09/07/2023

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