MEDICARE: YASHAR FARAHVASH

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	122300000X	Dentist	108596	CA
2	122300000X	Dentist	DN1856720	MA

General Provider Information

NPI Number	:	1588063838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASHAR FARAHVASH

Provider Business Mailing Address
First Line	:	2400 MOORPARK AVE STE 300
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2680
Country	:	US
Telephone Number	:	408-975-2730
Fax Number	:	408-975-2764

Provider Business Practice Location Address
First Line	:	266 N JACKSON AVE STE 1
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95116-1606
Country	:	US
Telephone Number	:	408-975-2731
Fax Number	:	408-975-2766

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	06/18/2026

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Directions to “ YASHAR FARAHVASH ” Practice Location

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