Healthcare Provider Details

I. General information

NPI: 1265407928
Provider Name (Legal Business Name): KAMRAN GHOREYSHI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 E 3RD ST SUITE C
CALEXICO CA
92231
US

IV. Provider business mailing address

408 E 3RD ST SUITE C
CALEXICO CA
92231
US

V. Phone/Fax

Practice location:
  • Phone: 760-357-9000
  • Fax: 760-357-9009
Mailing address:
  • Phone: 760-357-9000
  • Fax: 760-357-9009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number44481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: