Healthcare Provider Details

I. General information

NPI: 1942790860
Provider Name (Legal Business Name): S HOKMABADI DENTAL OFFICE A PROFESSIONAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2018
Last Update Date: 05/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2522 DANA ST STE 101
BERKELEY CA
94704-2803
US

IV. Provider business mailing address

2938 WEBSTER ST # 100
OAKLAND CA
94609-3407
US

V. Phone/Fax

Practice location:
  • Phone: 510-486-1813
  • Fax: 510-587-9977
Mailing address:
  • Phone: 510-768-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number50270
License Number StateCA

VIII. Authorized Official

Name: SEPAND HOKMABADI
Title or Position: OWNER
Credential: DDS
Phone: 510-768-7050