Healthcare Provider Details

I. General information

NPI: 1659637155
Provider Name (Legal Business Name): HOGHOOGHI, MASSOOMI, SODEIFI, SURPURE, DMD, MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2012
Last Update Date: 04/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 MAIN ST UNIT 1-A
SAN FRANCISCO CA
94105-5032
US

IV. Provider business mailing address

301 MAIN ST UNIT 1-A
SAN FRANCISCO CA
94105-5032
US

V. Phone/Fax

Practice location:
  • Phone: 415-813-6400
  • Fax: 415-813-6401
Mailing address:
  • Phone: 415-813-6400
  • Fax: 415-813-6401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXANDER HOGHOOGHI
Title or Position: SURGEON
Credential: DDS MD
Phone: 415-813-6400