Healthcare Provider Details

I. General information

NPI: 1174900583
Provider Name (Legal Business Name): VAHID EBRAHIMIAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5450 THORNWOOD DR STE B
SAN JOSE CA
95123-1222
US

IV. Provider business mailing address

5450 THORNWOOD DR STE B
SAN JOSE CA
95123-1222
US

V. Phone/Fax

Practice location:
  • Phone: 408-360-0270
  • Fax: 408-360-0275
Mailing address:
  • Phone: 408-360-0270
  • Fax: 408-360-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number50904
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: