Provider Demographics
NPI:1407114499
Name:DEYHIM, NILOOFAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:NILOOFAR
Middle Name:
Last Name:DEYHIM
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 1:3550 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:408-608-8012
Mailing Address - Fax:
Practice Address - Street 1:853 MIDDLEFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2900
Practice Address - Country:US
Practice Address - Phone:650-389-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-26
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62011204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery