Provider Demographics
NPI:1295814648
Name:ELAHIYOUN, ELHAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELHAM
Middle Name:
Last Name:ELAHIYOUN
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 1:48 DUNBAR CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2151
Mailing Address - Country:US
Mailing Address - Phone:925-325-2293
Mailing Address - Fax:
Practice Address - Street 1:8014 LOWER SACRAMENTO RD STE B
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3747
Practice Address - Country:US
Practice Address - Phone:209-478-9999
Practice Address - Fax:209-478-0337
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53701122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist