1629260138 NPI number — SHAHRAM AMERIPOUR DDS INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629260138 NPI number — SHAHRAM AMERIPOUR DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHAHRAM AMERIPOUR DDS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629260138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/30/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3826 SEVEN TREES BLVD #300
Provider Second Line Business Practice Location Address:
#300
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-363-6464
Provider Business Practice Location Address Fax Number:
408-363-6463
Provider Enumeration Date:
08/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AMERIPOUR
Authorized Official First Name:
SHAHRAM
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
818-203-4272

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4083636464 . This is a "4083636464" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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