Provider Demographics
NPI:1124402177
Name:MASHOUF, KAYHAN LAWRENCE (DMD)
Entity Type:Individual
Prefix:
First Name:KAYHAN
Middle Name:LAWRENCE
Last Name:MASHOUF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 WESTWOOD DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-5111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1670 WESTWOOD DR
Practice Address - Street 2:SUITE E
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5111
Practice Address - Country:US
Practice Address - Phone:408-266-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-18
Last Update Date:2015-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA623781223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics