Provider Demographics
NPI:1861010928
Name:LIPKIN, PARDIS FARHADIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PARDIS
Middle Name:FARHADIAN
Last Name:LIPKIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PARDIS
Other - Middle Name:
Other - Last Name:FARHADIAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:736 WALNUT ST APT 6
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3151
Mailing Address - Country:US
Mailing Address - Phone:650-906-4463
Mailing Address - Fax:
Practice Address - Street 1:707 PARNASSUS AVE FL 1
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2210
Practice Address - Country:US
Practice Address - Phone:650-906-4463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104621390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program