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General NPI Number Information
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NPI Number | 1427751650
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Entity Type | Individual
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Provider Name | KIMYA KHODAMARDI DMD
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Gender | Female
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Dates
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Enumeration Date | 03/27/2023
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 1141 PEAR TREE LN
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City | NAPA
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State | CA
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Zip | 94558-6484
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Country | US
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Telephone | 707-254-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 901 SUNVALLEY BLVD STE 110
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City | CONCORD
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State | CA
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Zip | 94520-5816
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Country | US
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Telephone |
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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 | DDS109818
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License Number State | CA
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