Provider Demographics
NPI:1821763038
Name:BARZIN POURFARROKH DDS INC
Entity Type:Organization
Organization Name:BARZIN POURFARROKH DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARZIN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:POURFARROKH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-350-1806
Mailing Address - Street 1:62 SAN JACINTO WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-2033
Mailing Address - Country:US
Mailing Address - Phone:415-350-1806
Mailing Address - Fax:
Practice Address - Street 1:220 MONTGOMERY ST STE 110
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94104-3405
Practice Address - Country:US
Practice Address - Phone:415-399-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-10
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty