Healthcare Provider Details

I. General information

NPI: 1982621942
Provider Name (Legal Business Name): KIAN FARZANEH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 11/06/2019
Certification Date:
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:
Title or Position:
Credential:
Phone: