Healthcare Provider Details

I. General information

NPI: 1841976438
Provider Name (Legal Business Name): SARAVANAN NAMBI BDS, DDS, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N EL CAMINO REAL
SAN MATEO CA
94401-3710
US

IV. Provider business mailing address

430 N EL CAMINO REAL
SAN MATEO CA
94401-3710
US

V. Phone/Fax

Practice location:
  • Phone: 650-727-3480
  • Fax: 650-727-3519
Mailing address:
  • Phone: 650-727-3480
  • Fax: 650-727-3519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number113254
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: