Provider Demographics
NPI:1346654357
Name:HAMED, SHIRIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHIRIN
Middle Name:
Last Name:HAMED
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LITTLEFIELD TER
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94107-3277
Mailing Address - Country:US
Mailing Address - Phone:858-442-9287
Mailing Address - Fax:
Practice Address - Street 1:1851 SUTTER ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2559
Practice Address - Country:US
Practice Address - Phone:800-327-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA642251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20709Medicaid