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General NPI Number Information
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NPI Number | 1578606844
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Entity Type | Individual
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Provider Name | TOURAJ KHALILZADEH DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 1981 N BROADWAY SUITE 180
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City | WALNUT CREEK
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State | CA
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Zip | 94596-3852
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Country | US
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Telephone | 925-478-4583
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Fax | 925-357-3899
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Provider Business Mailing Address
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Address Line | 1375 LICK AVE #223
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City | SAN JOSE
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State | CA
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Zip | 95110-3248
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Country | US
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Telephone | 443-527-6884
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | A121945
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License Number State | CA
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