Healthcare Provider Details

I. General information

NPI: 1407161045
Provider Name (Legal Business Name): PAYMON BAHRAMI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3227 STATE ST
SANTA BARBARA CA
93105-3328
US

IV. Provider business mailing address

1113 GARFIELD AVE
ALBANY CA
94706-1212
US

V. Phone/Fax

Practice location:
  • Phone: 805-696-1002
  • Fax:
Mailing address:
  • Phone: 415-504-1989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number59594
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: