Healthcare Provider Details

I. General information

NPI: 1215035696
Provider Name (Legal Business Name): ARSALAN AHANI D.D.S, M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: A. SAL AHANI D.D.S, M.D.

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 N SAN MATEO DR
SAN MATEO CA
94401-2824
US

IV. Provider business mailing address

30 N SAN MATEO DR
SAN MATEO CA
94401-2824
US

V. Phone/Fax

Practice location:
  • Phone: 650-340-6141
  • Fax: 650-340-6142
Mailing address:
  • Phone: 650-340-6141
  • Fax: 650-340-6142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number42966
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License NumberA97353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: