Healthcare Provider Details

I. General information

NPI: 1073318945
Provider Name (Legal Business Name): SEYED EMADALDIN AMINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2025
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 STORY RD STE 100
SAN JOSE CA
95122-1927
US

IV. Provider business mailing address

1775 STORY RD STE 100
SAN JOSE CA
95122-1927
US

V. Phone/Fax

Practice location:
  • Phone: 408-928-5858
  • Fax:
Mailing address:
  • Phone: 408-928-5858
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN30995
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number112405
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: