Healthcare Provider Details

I. General information

NPI: 1558430207
Provider Name (Legal Business Name): SAMIR NANJAPA DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1528 S EL CAMINO REAL SUITE 408
SAN MATEO CA
94402-3060
US

IV. Provider business mailing address

60 BARNESON AVE
SAN MATEO CA
94402-2906
US

V. Phone/Fax

Practice location:
  • Phone: 650-477-6920
  • Fax: 650-212-3505
Mailing address:
  • Phone: 415-216-5068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number019026323
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number55840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: