Provider Demographics
NPI:1407452329
Name:NANDAN, VISHNU (DDS, BDS)
Entity Type:Individual
Prefix:DR
First Name:VISHNU
Middle Name:
Last Name:NANDAN
Suffix:
Gender:M
Credentials:DDS, BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 S FULLER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3246
Mailing Address - Country:US
Mailing Address - Phone:415-418-8112
Mailing Address - Fax:
Practice Address - Street 1:2626 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3102
Practice Address - Country:US
Practice Address - Phone:415-285-9847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS105790122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty