Provider Demographics
NPI:1396394862
Name:RAHIMI, NAZANIN
Entity Type:Individual
Prefix:
First Name:NAZANIN
Middle Name:
Last Name:RAHIMI
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 1:591 ARRAN CT
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087-3305
Mailing Address - Country:US
Mailing Address - Phone:650-996-4987
Mailing Address - Fax:
Practice Address - Street 1:591 ARRAN CT
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-3305
Practice Address - Country:US
Practice Address - Phone:650-996-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist