MEDICARE: KAMRAN MASHOUF DDS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	27171	CA

General Provider Information

NPI Number	:	1710173497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAMRAN MASHOUF DDS

Provider Business Mailing Address
First Line	:	1670 WESTWOOD DR.
Second Line	:	SUITE E
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5111
Country	:	US
Telephone Number	:	408-266-8820
Fax Number	:	408-266-8856

Provider Business Practice Location Address
First Line	:	1670 WESTWOOD DR
Second Line	:	SUITE E
City	:	SAN JOSE
State	:	CA
Zip	:	95125-5111
Country	:	US
Telephone Number	:	408-266-8820
Fax Number	:	408-266-8856

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

Provider Enumeration Date	:	09/17/2007
Last Update Date	:	09/17/2007

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