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General NPI Number Information
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NPI Number | 1083129183
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Entity Type | Individual
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Provider Name | NELISHAH JIWANI DMD, CAGS
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Gender | Female
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Dates
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Enumeration Date | 12/12/2017
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Last Update Date | 02/15/2022
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Provider Practice Location Address
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Address Line | 809 CUESTA DR STE 205
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-3666
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Country | US
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Telephone | 650-967-1441
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Fax |
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Provider Business Mailing Address
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Address Line | 25 JODY CT
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City | SAN MATEO
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State | CA
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Zip | 94402-2615
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Country | US
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Telephone | 415-429-9632
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102072
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License Number State | CA
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