MEDICARE: PARDIS GHOLAMI 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	122300000X	Dentist	111818	CA

General Provider Information

NPI Number	:	1851264824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PARDIS GHOLAMI DDS

Provider Business Mailing Address
First Line	:	11251 RANCHO CARMEL DR
Second Line	:	PO BOX 500286
City	:	SAN DIEGO
State	:	CA
Zip	:	92199
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5830 OBERLIN DR STE 200
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-3754
Country	:	US
Telephone Number	:	858-453-4003
Fax Number	:

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

Provider Enumeration Date	:	09/25/2025
Last Update Date	:	01/28/2026

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Directions to “ PARDIS GHOLAMI DDS” Practice Location

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