Provider Demographics
NPI:1578004818
Name:SHERVIN YAZDI DDS, INC
Entity Type:Organization
Organization Name:SHERVIN YAZDI DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERVIN
Authorized Official - Middle Name:KHOSHNEVIS
Authorized Official - Last Name:YAZDI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:510-538-2098
Mailing Address - Street 1:20700 LAKE CHABOT RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5401
Mailing Address - Country:US
Mailing Address - Phone:510-538-2098
Mailing Address - Fax:
Practice Address - Street 1:20700 LAKE CHABOT RD
Practice Address - Street 2:SUITE 205
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5401
Practice Address - Country:US
Practice Address - Phone:510-538-2098
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental