Healthcare Provider Details

I. General information

NPI: 1760168587
Provider Name (Legal Business Name): FATEMA KERMANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 MISSION ST STE 323
SAN FRANCISCO CA
94110-2463
US

IV. Provider business mailing address

47260 ARMATA ST
FREMONT CA
94539-7800
US

V. Phone/Fax

Practice location:
  • Phone: 619-996-9543
  • Fax:
Mailing address:
  • Phone: 502-409-2880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS112403
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberD011841
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: