Provider Demographics
NPI:1467773861
Name:KHASHAYAR, FARZIN (DDS)
Entity Type:Individual
Prefix:
First Name:FARZIN
Middle Name:
Last Name:KHASHAYAR
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 1:8105 EDGEWATER DR STE 250
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94621-2017
Mailing Address - Country:US
Mailing Address - Phone:510-568-6272
Mailing Address - Fax:510-636-1942
Practice Address - Street 1:8105 EDGEWATER DR STE 250
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94621-2017
Practice Address - Country:US
Practice Address - Phone:510-568-6272
Practice Address - Fax:510-636-1942
Is Sole Proprietor?:No
Enumeration Date:2010-06-20
Last Update Date:2010-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice