Provider Demographics
NPI:1134297112
Name:VAGHAYE-NEGARI, KAMYAR (DDS)
Entity Type:Individual
Prefix:
First Name:KAMYAR
Middle Name:
Last Name:VAGHAYE-NEGARI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KAMYAR
Other - Middle Name:
Other - Last Name:NEGARI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14495 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2002
Mailing Address - Country:US
Mailing Address - Phone:408-377-8302
Mailing Address - Fax:
Practice Address - Street 1:14495 S BASCOM AVE
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2002
Practice Address - Country:US
Practice Address - Phone:408-377-8302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADS52482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADS0524820Medicare PIN
CAV00613Medicare UPIN