Provider Demographics
NPI:1639224066
Name:NOORDEH, KATHY (DDS)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:NOORDEH
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 1:450 SUTTER ST. RM 2419
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4203
Mailing Address - Country:US
Mailing Address - Phone:415-296-8580
Mailing Address - Fax:415-296-8426
Practice Address - Street 1:450 SUTTER ST RM 2419
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4203
Practice Address - Country:US
Practice Address - Phone:415-296-8580
Practice Address - Fax:415-296-8426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA356461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice