Healthcare Provider Details

I. General information

NPI: 1861207771
Provider Name (Legal Business Name): MAHDOKHT YOUSEFIAN DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2025
Last Update Date: 02/08/2025
Certification Date: 02/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 HELLYER AVE STE 125
SAN JOSE CA
95138-1066
US

IV. Provider business mailing address

3167 MARTINGALE DR
DANVILLE CA
94506-5001
US

V. Phone/Fax

Practice location:
  • Phone: 408-490-0182
  • Fax: 408-624-4545
Mailing address:
  • Phone: 925-519-8626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHDOKHT YOUSEFIAN
Title or Position: PROVIDER
Credential: DDS
Phone: 925-519-8626