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General NPI Number Information
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NPI Number | 1295948719
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Entity Type | Individual
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Provider Name | KIAN NABAVIZADEH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 797 S TRACY BLVD
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City | TRACY
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State | CA
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Zip | 95376-4753
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Country | US
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Telephone | 209-839-8594
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Fax | 209-839-9372
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Provider Business Mailing Address
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Address Line | 37 HURST CT
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City | SAN RAMON
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State | CA
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Zip | 94583-4782
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Country | US
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Telephone | 925-875-1414
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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 | 42190
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License Number State | CA
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