Provider Demographics
NPI:1578621470
Name:KIRAN, VIJAYA SHASHI (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:SHASHI
Last Name:KIRAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2958 ARCHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2614
Mailing Address - Country:US
Mailing Address - Phone:408-406-3842
Mailing Address - Fax:
Practice Address - Street 1:1721 STORY RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-1922
Practice Address - Country:US
Practice Address - Phone:408-406-3842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA506261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice