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General NPI Number Information
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NPI Number | 1699232108
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Entity Type | Organization
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Legal Business Name | KAYHAN MASHOUF DMD INC
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Dates
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Enumeration Date | 02/21/2019
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Last Update Date | 02/21/2019
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Provider Practice Location Address
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Address Line | 270 GREEN VALLEY RD
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City | FREEDOM
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State | CA
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Zip | 95019
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Country | US
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Telephone | 408-674-3146
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Fax |
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Provider Business Mailing Address
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Address Line | 1762 HALLMARK LN
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City | SAN JOSE
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State | CA
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Zip | 95124
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Country | US
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Telephone | 408-674-3146
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KAYHAN LAWRENCE MASHOUF
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Credential | DMD
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Telephone | 408-674-3146
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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