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General NPI Number Information
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NPI Number | 1649995655
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Entity Type | Individual
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Provider Name | OMID JONATHAN ELIE DDS
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Gender | Male
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1289 E HILLSDALE BLVD STE 3
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City | FOSTER CITY
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State | CA
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Zip | 94404-1219
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Country | US
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Telephone | 650-572-8518
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Fax | 650-572-8582
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Provider Business Mailing Address
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Address Line | 148 FLYING MIST ISLE
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City | FOSTER CITY
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State | CA
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Zip | 94404-1402
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Country | US
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Telephone | 650-573-5670
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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 | 108202
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License Number State | CA
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