Healthcare Provider Details

I. General information

NPI: 1821829946
Provider Name (Legal Business Name): CUCALON AND MATIN ORTHODONTICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 08/10/2024
Certification Date: 08/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2078 UNION ST
SAN FRANCISCO CA
94123-4103
US

IV. Provider business mailing address

2078 UNION ST
SAN FRANCISCO CA
94123-4103
US

V. Phone/Fax

Practice location:
  • Phone: 415-563-2348
  • Fax:
Mailing address:
  • Phone: 415-563-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ELHAM ZIAIE MATIN
Title or Position: PARTNER OWNER
Credential: DMD
Phone: 415-563-2348