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General NPI Number Information
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NPI Number | 1235229337
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Entity Type | Individual
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Provider Name | JAYDEEP SHASHIKUMAR TALIM D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/13/2006
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Last Update Date | 01/05/2022
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Provider Practice Location Address
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Address Line | 770 MAGNOLIA AVE STE 1J
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City | CORONA
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State | CA
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Zip | 92879-3100
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Country | US
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Telephone | 951-736-0603
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Fax |
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Provider Business Mailing Address
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Address Line | 55 TURNBURY LN
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City | IRVINE
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State | CA
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Zip | 92620-0244
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Country | US
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Telephone | 714-310-8553
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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 | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 46143
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License Number State | CA
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