Healthcare Provider Details

I. General information

NPI: 1518186147
Provider Name (Legal Business Name): SEPIDEH VAFI DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PALMETTO AVE STE F
PACIFICA CA
94044-2273
US

IV. Provider business mailing address

1301 PALMETTO AVE STE F
PACIFICA CA
94044-2273
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-2100
  • Fax: 650-738-9680
Mailing address:
  • Phone: 650-738-2100
  • Fax: 650-738-9680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number42245
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: