Provider Demographics
NPI:1043400294
Name:ANSARINIA, KATHY K (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHY
Middle Name:K
Last Name:ANSARINIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 N 1ST ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95134-2025
Mailing Address - Country:US
Mailing Address - Phone:408-943-9443
Mailing Address - Fax:408-943-8929
Practice Address - Street 1:2680 N 1ST ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95134-2025
Practice Address - Country:US
Practice Address - Phone:408-943-9443
Practice Address - Fax:408-943-8929
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice