Provider Demographics
NPI:1245370287
Name:HATAMI, KUROSCH (DDS)
Entity type:Individual
Prefix:DR
First Name:KUROSCH
Middle Name:
Last Name:HATAMI
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 1:359 N SAN MATEO DR
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2560
Mailing Address - Country:US
Mailing Address - Phone:650-344-1724
Mailing Address - Fax:650-344-1521
Practice Address - Street 1:359 N SAN MATEO DR
Practice Address - Street 2:SUITE #1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2560
Practice Address - Country:US
Practice Address - Phone:650-344-1724
Practice Address - Fax:650-344-1521
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA421551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice