Healthcare Provider Details

I. General information

NPI: 1407114499
Provider Name (Legal Business Name): NILOOFAR DEYHIM DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

853 MIDDLEFIELD RD STE 1
PALO ALTO CA
94301-2900
US

IV. Provider business mailing address

3550 ALDEN WAY APT 15
SAN JOSE CA
95117-1569
US

V. Phone/Fax

Practice location:
  • Phone: 650-389-9222
  • Fax:
Mailing address:
  • Phone: 408-608-8012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number62011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: