Provider Demographics
NPI:1407161045
Name:BAHRAMI, PAYMON (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAYMON
Middle Name:
Last Name:BAHRAMI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1212
Mailing Address - Country:US
Mailing Address - Phone:415-504-1989
Mailing Address - Fax:
Practice Address - Street 1:1113 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1212
Practice Address - Country:US
Practice Address - Phone:415-504-1989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice