Provider Demographics
NPI:1053584243
Name:HOSSEINI, AZADEH (DDS)
Entity type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:HOSSEINI
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 1:2227 GRANITE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507-1604
Mailing Address - Country:US
Mailing Address - Phone:408-425-1056
Mailing Address - Fax:
Practice Address - Street 1:38350 FREMONT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-6060
Practice Address - Country:US
Practice Address - Phone:510-795-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice