Healthcare Provider Details

I. General information

NPI: 1285761411
Provider Name (Legal Business Name): KIAN FARZANEH D.D.S., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 SAN RAMON VALLEY BLVD STE A
DANVILLE CA
94526-4027
US

IV. Provider business mailing address

801 SAN RAMON VALLEY BLVD STE A
DANVILLE CA
94526-4027
US

V. Phone/Fax

Practice location:
  • Phone: 925-831-9217
  • Fax: 925-831-9218
Mailing address:
  • Phone: 925-831-9217
  • Fax: 925-831-9218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number46587
License Number StateCA

VIII. Authorized Official

Name: DR. KIAN FARZANEH
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 925-831-9217