MEDICARE: DR. KIAN FARZANEH 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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	46587	CA

General Provider Information

NPI Number	:	1982621942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIAN FARZANEH DDS

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	11/06/2019

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