Healthcare Provider Details

I. General information

NPI: 1770626384
Provider Name (Legal Business Name): KSHAMA KHENY BDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9130 ALCOSTA BLVD STE A
SAN RAMON CA
94583-3847
US

IV. Provider business mailing address

2762 VISTA DIABLO CT
PLEASANTON CA
94566-7033
US

V. Phone/Fax

Practice location:
  • Phone: 925-803-9700
  • Fax:
Mailing address:
  • Phone: 925-895-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number45889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: