Healthcare Provider Details

I. General information

NPI: 1598336281
Provider Name (Legal Business Name): DR. HASHMAT JOHN KHORSAND
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 W MONTE VISTA AVE
TURLOCK CA
95380-8409
US

IV. Provider business mailing address

3935 BELLEZA DR
CERES CA
95307-7170
US

V. Phone/Fax

Practice location:
  • Phone: 209-667-2879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number106465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: