Healthcare Provider Details

I. General information

NPI: 1609702539
Provider Name (Legal Business Name): KIRAN AHMED DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2199 MAIN ST
OAKLEY CA
94561-3303
US

IV. Provider business mailing address

552 BIG BASIN DR
BRENTWOOD CA
94513-5451
US

V. Phone/Fax

Practice location:
  • Phone: 925-575-9504
  • Fax:
Mailing address:
  • Phone: 925-963-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113153
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: