Healthcare Provider Details

I. General information

NPI: 1770631228
Provider Name (Legal Business Name): KIRA ELDEMIR DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4162 24TH ST
SAN FRANCISCO CA
94114-3615
US

IV. Provider business mailing address

2452 WASHINGTON ST
SAN FRANCISCO CA
94115-1831
US

V. Phone/Fax

Practice location:
  • Phone: 415-285-7007
  • Fax: 415-285-1969
Mailing address:
  • Phone: 415-929-6944
  • Fax: 415-285-1969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: