Healthcare Provider Details

I. General information

NPI: 1407769391
Provider Name (Legal Business Name): FARANAK FAHIMIPOUR DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OAK GROVE AVE
MENLO PARK CA
94025-4432
US

IV. Provider business mailing address

288 CASITAS BULEVAR
LOS GATOS CA
95032-1118
US

V. Phone/Fax

Practice location:
  • Phone: 424-470-5721
  • Fax:
Mailing address:
  • Phone: 424-470-5721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: FARANAK FAHIMIPOUR
Title or Position: DENTIST
Credential: DDS
Phone: 424-470-5721