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General NPI Number Information
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NPI Number | 1477200897
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Entity Type | Individual
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Provider Name | KAMIAR VAEZ-GHAEMI
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Gender | Male
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Dates
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Enumeration Date | 03/05/2022
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Last Update Date | 07/14/2025
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Provider Practice Location Address
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Address Line | 107 S BROADWAY
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City | YONKERS
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State | NY
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Zip | 10701-4006
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Country | US
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Telephone | 914-378-7848
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Fax |
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Provider Business Mailing Address
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Address Line | 12 FILLMORE PL
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3706
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Country | US
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Telephone | 240-477-2558
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 063341
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License Number State | NY
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