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1568182681 NPI number — SEPEHR POURESA DMD

NPI Number: 1568182681
Health Care Provider/Practitioner: SEPEHR POURESA DMD

Information about “1568182681” NPI (SEPEHR POURESA DMD) exists in 1568182681 in HTML format HTML  |  1568182681 in plain Text format TXT  |  1568182681 in PDF (Portable Document Format) PDF  |  1568182681 in an XML format XML  formats.

NPI Number : 1568182681 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568182681",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "POURESA",
    "FirstName": "SEPEHR",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "POURESA",
    "OtherFirstName": "SEP",
    "OtherMiddleName": null,
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "400 BEALE ST APT 2505",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAN FRANCISCO",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "94105-4435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "415-806-4184",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "450 SUTTER ST RM 808",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAN FRANCISCO",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "94108-3910",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "415-513-5066",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/30/2022",
    "LastUpdateDate": "09/11/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "122300000X",
        "TaxonomyName": "Dentist",
        "LicenseNumber": "107800",
        "LicenseNumberStateCode": "CA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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