Provider Demographics
NPI:1407281041
Name:KARIMIAN, EHSAN (EHSAN KARIMIAN)
Entity Type:Individual
Prefix:
First Name:EHSAN
Middle Name:
Last Name:KARIMIAN
Suffix:
Gender:M
Credentials:EHSAN KARIMIAN
Other - Prefix:
Other - First Name:EHSAN
Other - Middle Name:
Other - Last Name:KARIMIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:908 E ST STE C
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-2851
Mailing Address - Country:US
Mailing Address - Phone:415-726-1298
Mailing Address - Fax:
Practice Address - Street 1:908 E ST STE C
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2851
Practice Address - Country:US
Practice Address - Phone:415-726-1298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2015-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA625391223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics