1174650543 NPI number — DR. SHIRIN SHAHINFAR IMANI DDS

Table of content: DR. SHIRIN SHAHINFAR IMANI DDS (NPI 1174650543)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174650543 NPI number — DR. SHIRIN SHAHINFAR IMANI DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IMANI
Provider First Name:
SHIRIN
Provider Middle Name:
SHAHINFAR
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
IMANI
Provider Other First Name:
SHIRIN
Provider Other Middle Name:
SHAHINFAR
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174650543
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
675 MARINERS ISLAND BLVD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
SAN MATEO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-577-1988
Provider Business Mailing Address Fax Number:
650-577-0835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
675 MARINERS ISLAND BLVD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
SAN MATEO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-577-1988
Provider Business Practice Location Address Fax Number:
650-577-0835
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  42093 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com