MEDICARE: SHAHRAM AMERIPOUR DDS 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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4083636464	OTHER	CA	4083636464

General Provider Information

NPI Number	:	1629260138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAHRAM AMERIPOUR DDS INC.

Provider Business Mailing Address
First Line	:	3826 SEVEN TREES BLVD #300
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	818-203-4272
Fax Number	:	408-363-6464

Provider Business Practice Location Address
First Line	:	3826 SEVEN TREES BLVD #300
Second Line	:	#300
City	:	SAN JOSE
State	:	CA
Zip	:	95111
Country	:	US
Telephone Number	:	408-363-6464
Fax Number	:	408-363-6463

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHAHRAM AMERIPOUR
Credential	:	D.D.S
Telephone Number	:	818-203-4272

Provider Enumeration Date	:	08/17/2007
Last Update Date	:	09/30/2022

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Directions to “SHAHRAM AMERIPOUR DDS INC. ” Practice Location

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