Provider Demographics
NPI:1215378039
Name:BALKHI, GHEZAL
Entity Type:Individual
Prefix:
First Name:GHEZAL
Middle Name:
Last Name:BALKHI
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 1:1301 STEVENSON BLVD
Mailing Address - Street 2:# 324
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2984
Mailing Address - Country:US
Mailing Address - Phone:510-688-9707
Mailing Address - Fax:
Practice Address - Street 1:38062 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-3809
Practice Address - Country:US
Practice Address - Phone:510-792-9292
Practice Address - Fax:510-792-9296
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80318126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant