Provider Demographics
NPI:1689883563
Name:HOKMABADI, SEPAND (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEPAND
Middle Name:
Last Name:HOKMABADI
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 1:2195 BEACH ST APT 104
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-1461
Mailing Address - Country:US
Mailing Address - Phone:415-830-1588
Mailing Address - Fax:510-655-6374
Practice Address - Street 1:1880 PLEASANT VALLEY AVE STE F
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4211
Practice Address - Country:US
Practice Address - Phone:510-654-5752
Practice Address - Fax:510-655-6374
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA502701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA87-0766116OtherTAX I.D. NUMBER