Provider Demographics
NPI:1669857009
Name:KAMALI, YASAMAN (DDS)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:KAMALI
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 1:2323 RACE ST UNIT 321
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1075
Mailing Address - Country:US
Mailing Address - Phone:310-779-7648
Mailing Address - Fax:
Practice Address - Street 1:2459 ARAMINGO AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3731
Practice Address - Country:US
Practice Address - Phone:215-427-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-28
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS040482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist