MEDICARE: KIAN FARZANEH D.D.S., INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	46587	CA

General Provider Information

NPI Number	:	1285761411
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIAN FARZANEH D.D.S., INC

Provider Business Mailing Address
First Line	:	801 SAN RAMON VALLEY BLVD STE A
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4027
Country	:	US
Telephone Number	:	925-831-9217
Fax Number	:	925-831-9218

Provider Business Practice Location Address
First Line	:	801 SAN RAMON VALLEY BLVD STE A
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-4027
Country	:	US
Telephone Number	:	925-831-9217
Fax Number	:	925-831-9218

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. KIAN FARZANEH
Credential	:	D.D.S.
Telephone Number	:	925-831-9217

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	05/21/2021

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