Provider Demographics
NPI:1013646918
Name:AMIRI, ROHYA KOHGADAI
Entity Type:Individual
Prefix:
First Name:ROHYA
Middle Name:KOHGADAI
Last Name:AMIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 WATERFALL ISLE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5648
Mailing Address - Country:US
Mailing Address - Phone:510-919-5270
Mailing Address - Fax:
Practice Address - Street 1:MARIN COMMUNITY CLINICS
Practice Address - Street 2:411 4 TH STREET
Practice Address - City:SAN RAFAEL, CA 94901
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-448-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27867124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist