Provider Demographics
NPI:1154834000
Name:NILOOFAR DEYHIM DDS INC
Entity Type:Organization
Organization Name:NILOOFAR DEYHIM DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:NILOOFAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DEYHIM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-608-8012
Mailing Address - Street 1:3550 ALDEN WAY APT 15
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1569
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1316 COFFEE RD STE E14
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3191
Practice Address - Country:US
Practice Address - Phone:209-522-9963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-14
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty